Provider Demographics
NPI:1497332563
Name:GRAHAM FAMILY ADULT DAYCARE INC.
Entity Type:Organization
Organization Name:GRAHAM FAMILY ADULT DAYCARE INC.
Other - Org Name:GRAHAM FAMILY ADULT DAYCARE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-567-3141
Mailing Address - Street 1:115 HUNTINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7720
Mailing Address - Country:US
Mailing Address - Phone:917-567-3141
Mailing Address - Fax:
Practice Address - Street 1:115 HUNTINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7720
Practice Address - Country:US
Practice Address - Phone:917-567-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty