Provider Demographics
NPI:1679621817
Name:GRAY ALTERNATIVE CARE
Entity Type:Organization
Organization Name:GRAY ALTERNATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISIMAE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-663-2562
Mailing Address - Street 1:401 GREENHILL DR
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-4003
Mailing Address - Country:US
Mailing Address - Phone:919-663-2562
Mailing Address - Fax:919-663-2643
Practice Address - Street 1:401 GREENHILL DR
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-4003
Practice Address - Country:US
Practice Address - Phone:919-663-2562
Practice Address - Fax:919-663-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 019 039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805371Medicaid
NC3418160Medicaid