Provider Demographics
NPI:1629097704
Name:GRAY FUNERAL HOME INC
Entity Type:Organization
Organization Name:GRAY FUNERAL HOME INC
Other - Org Name:CULBERSON FUNERAL HOME INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FUNERAL DIRECTOR EMT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CULBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-489-5511
Mailing Address - Street 1:51 SOUTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1547
Mailing Address - Country:US
Mailing Address - Phone:765-489-5511
Mailing Address - Fax:765-489-5936
Practice Address - Street 1:51 SOUTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-1547
Practice Address - Country:US
Practice Address - Phone:765-489-5511
Practice Address - Fax:765-489-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN890045341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100282140AMedicaid
IN979660Medicare ID - Type Unspecified