Provider Demographics
NPI:1932328572
Name:GRAND MANNER, INC
Entity Type:Organization
Organization Name:GRAND MANNER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-428-9082
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-0040
Mailing Address - Country:US
Mailing Address - Phone:440-428-9082
Mailing Address - Fax:440-428-5399
Practice Address - Street 1:1954 HUBBARD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2154
Practice Address - Country:US
Practice Address - Phone:440-428-9082
Practice Address - Fax:440-428-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4300992Medicaid