Provider Demographics
NPI:1588175913
Name:GRANT HOUSE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:GRANT HOUSE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT-CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-701-7732
Mailing Address - Street 1:4920 BELAIR RD SUITE 2C & 2D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-3724
Mailing Address - Country:US
Mailing Address - Phone:410-732-0236
Mailing Address - Fax:
Practice Address - Street 1:4920 BELAIR RD STE 2C&2D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5601
Practice Address - Country:US
Practice Address - Phone:410-732-0236
Practice Address - Fax:443-449-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD500265600Medicaid