Provider Demographics
NPI:1639252901
Name:ANNE GRADY CORPORATION
Entity Type:Organization
Organization Name:ANNE GRADY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-866-6500
Mailing Address - Street 1:1525 EBER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9616
Mailing Address - Country:US
Mailing Address - Phone:419-866-6500
Mailing Address - Fax:419-866-7457
Practice Address - Street 1:1525 EBER RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9616
Practice Address - Country:US
Practice Address - Phone:419-866-6500
Practice Address - Fax:419-866-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0523768315P00000X, 385HR2060X
OH4800139320900000X
343900000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4800139Medicaid
OH0523768Medicaid
OH1280440001Medicare NSC
OH9265381Medicare UPIN
OH0523768Medicaid
OH9265381Medicare PIN
OH4800139Medicaid