Provider Demographics
NPI:1245719236
Name:GROSSMAN & GROSSMAN, LTD.
Entity type:Organization
Organization Name:GROSSMAN & GROSSMAN, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-410-6635
Mailing Address - Street 1:PO BOX 14948
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4948
Mailing Address - Country:US
Mailing Address - Phone:602-410-6635
Mailing Address - Fax:
Practice Address - Street 1:5929 E CHARTER OAK RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4348
Practice Address - Country:US
Practice Address - Phone:602-410-6635
Practice Address - Fax:480-609-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ542301Medicaid