Organization
GRADEN PROVISION OF PROMISE OUTREACH ORG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE WALTER SMITH JR. (CEO)
(989) 753-5477
Entity
Organization
Contact information
Practice address
2421 SHERIDAN AVE, SAGINAW, MI 48601-3613
(989) 753-5477
(989) 753-7461
Mailing address
2421 SHERIDAN AVE, SAGINAW, MI 48601-3613
(989) 753-5477
(989) 753-7461
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/16/2012
Last updated
02/16/2012
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