Provider Demographics
NPI:1245305002
Name:ANNE GRADY DAY PROGRAM
Entity type:Organization
Organization Name:ANNE GRADY DAY PROGRAM
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 1:1645 TRADE RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8204
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:2006-11-21
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2696168Medicaid
OH2770130Medicaid
OH367657OtherMEDICARE
OH4802897Medicaid