Provider Demographics
NPI:1609961713
Name:GRANT COUNTY SENIOR SERVICES INC
Entity Type:Organization
Organization Name:GRANT COUNTY SENIOR SERVICES INC
Other - Org Name:ACCSSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-388-2523
Mailing Address - Street 1:2610 N SILVER STREET
Mailing Address - Street 2:P O BOX 2990
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-2990
Mailing Address - Country:US
Mailing Address - Phone:505-388-2523
Mailing Address - Fax:505-388-5118
Practice Address - Street 1:2610 N SILVER STREET
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88062-2990
Practice Address - Country:US
Practice Address - Phone:505-388-2523
Practice Address - Fax:505-388-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13371011Medicaid