Provider Demographics
NPI:1184120776
Name:GRAY GROUP L.L.C.
Entity type:Organization
Organization Name:GRAY GROUP L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURRAY-GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:386-457-8159
Mailing Address - Street 1:637 SPREADING OAK AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9003
Mailing Address - Country:US
Mailing Address - Phone:386-457-8159
Mailing Address - Fax:
Practice Address - Street 1:637 SPREADING OAK AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738
Practice Address - Country:US
Practice Address - Phone:386-457-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL1-13-13430251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1977826063Medicaid