Organization
ANNE GRADY CORPORATION
Active
Other names
South Street ICF
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN KING (EXECUTIVE DIRECTOR)
(419) 866-6500
Entity
Organization
Contact information
Practice address
1525 EBER RD, HOLLAND, OH 43528-9616
(419) 866-6500
(419) 866-7457
Mailing address
PO BOX 1297, HOLLAND, OH 43528-1297
(419) 866-6500
(419) 866-7457
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0194828
—
OH
Enumeration date
10/12/2015
Last updated
04/15/2022
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