Provider Demographics
NPI:1013556687
Name:GREYSTONE HOUSE 2, LLC
Entity Type:Organization
Organization Name:GREYSTONE HOUSE 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-525-5468
Mailing Address - Street 1:27490 N HIGUERA DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4859
Mailing Address - Country:US
Mailing Address - Phone:602-525-5468
Mailing Address - Fax:602-467-3153
Practice Address - Street 1:27490 N HIGUERA DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4859
Practice Address - Country:US
Practice Address - Phone:602-525-5468
Practice Address - Fax:602-467-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health