Provider Demographics
NPI:1245679620
Name:GROSSMAN & GROSSMAN, LTD.
Entity type:Organization
Organization Name:GROSSMAN & GROSSMAN, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:BIRDELL
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW MED
Authorized Official - Phone:602-410-6637
Mailing Address - Street 1:PO BOX 14948
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267
Mailing Address - Country:US
Mailing Address - Phone:602-410-6635
Mailing Address - Fax:480-609-9552
Practice Address - Street 1:1300 N 12TH ST STE 550
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2820
Practice Address - Country:US
Practice Address - Phone:602-468-2077
Practice Address - Fax:480-609-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4275251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825703Medicaid