# GREHABCORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174776223
- **Authorized official:** GAYLE DJENABA JACKSON (OTR/L)
- **Authorized official phone:** (516) 665-8935

## Contact information

- **Practice address:** 725 MILLER AVE, FREEPORT, NY 11520-6350
- **Practice address phone:** (516) 991-6800
- **Mailing address:** 725 MILLER AVE, FREEPORT, NY 11520-6350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 083831 | NY | Yes |

## Other

- **Enumeration date:** 11/01/2008
- **Last updated:** 11/01/2008