Provider Demographics
NPI:1518607332
Name:GRUNDY AREA P. A. D. S.
Entity Type:Organization
Organization Name:GRUNDY AREA P. A. D. S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-942-3245
Mailing Address - Street 1:1409 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1445
Mailing Address - Country:US
Mailing Address - Phone:815-942-3245
Mailing Address - Fax:
Practice Address - Street 1:1409 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1445
Practice Address - Country:US
Practice Address - Phone:815-942-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health