Provider Demographics
NPI:1558048207
Name:GRAND TRAVERSE RESOURCE CENTER
Entity Type:Organization
Organization Name:GRAND TRAVERSE RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-360-8705
Mailing Address - Street 1:1209 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2938
Mailing Address - Country:US
Mailing Address - Phone:231-360-8705
Mailing Address - Fax:231-252-4494
Practice Address - Street 1:1209 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2938
Practice Address - Country:US
Practice Address - Phone:231-360-8705
Practice Address - Fax:231-252-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251300000XAgenciesLocal Education Agency (LEA)
No251V00000XAgenciesVoluntary or Charitable