ANNE GRADY CORPORATION (NPI# 1528439932) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528439932 |
| Entity Type | Organization |
| Organization Name | ANNE GRADY CORPORATION |
| Other Organization Name | SOUTH STREET ICF |
| Practice Address |
1525 Eber Rd Holland OH 43528-9616 |
| Mailing Address |
Po Box 1297 Holland OH 43528-1297 |
| Practice Telephone | 4198666500 |
| Practice Fax Number | 4198667457 |
| Mailing Telephone | 4198666500 |
| Mailing Fax Number | 4198667457 |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2018-09-25 |
| Authorized Official Name | MR. ROGER FORTENER (ASSOC EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4198666500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0194828 | 05 |
| Other Name | Type Code |
|---|---|
| South Street ICF | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598135493 | Anne Grady Corporation | Intermediate Care Facility, Mentally Retarded | 7053 Dorr St, Toledo, OH 43615-4105 | 2015-10-05 |
| 1134456759 | Anne Grady Corporation | Ambulance | 2955 Gradwohl Rd, Toledo, OH 43617-1507 | 2009-11-04 |
| 1477798502 | Anne Grady Corporation | Intermediate Care Facility, Mentally Retarded | 1601 Eber Rd, Holland, OH 43528-8213 | 2008-12-03 |
| 1114172905 | Anne Grady Corporation | Intermediate Care Facility, Mentally Retarded | 5923 Everwood Rd, Toledo, OH 43613-1231 | 2008-11-21 |
| 1639252901 | Anne Grady Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1525 Eber Rd, Holland, OH 43528-9616 | 2006-10-23 |
| 1285988717 | Anne Grady Corporation | Clinic/Center | 1525 Eber Rd, Holland, OH 43528-9616 | 2012-11-06 |
| 1346529591 | Anne Grady Corporation | Clinic/Center | 1525 Eber Rd, Holland, OH 43528-9616 | 2011-08-05 |
| Street Address |
1525 EBER RD |
| City | HOLLAND |
| State | OH |
| Zip Code | 43528-9616 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639252901 | Anne Grady Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1525 Eber Rd, Holland, OH 43528-9616 | 2006-10-23 |
| 1114357514 | Jeremy Kestner | Physical Therapy Assistant | 1525 Eber Rd, Holland, OH 43528-9616 | 2013-11-21 |
| 1285988717 | Anne Grady Corporation | Clinic/Center | 1525 Eber Rd, Holland, OH 43528-9616 | 2012-11-06 |
| 1346529591 | Anne Grady Corporation | Clinic/Center | 1525 Eber Rd, Holland, OH 43528-9616 | 2011-08-05 |
| 1154636744 | Jane Marie Fortener | Occupational Therapist | 1525 Eber Rd, Holland, OH 43528-9616 | 2010-08-09 |
| 1417262007 | Christine Marian Kudlak | Speech-Language Pathologist | 1525 Eber Rd, Holland, OH 43528-9616 | 2010-08-09 |
| 1033237953 | Colleen Catherine Tye | Physical Therapist | 1525 Eber Rd, Holland, OH 43528-9616 | 2007-03-27 |
| 1780702332 | Pam Jean Brosius | Physical Therapist | 1525 Eber Rd, Holland, OH 43528-9616 | 2007-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215542345 | Bobbi Stall | Technician | 1027 Raymil, Holland, OH 43528 | 2020-09-15 |
| 1336789049 | Diana Kobylak | Licensed Practical Nurse | Racing for Recovery, 6202 Trust Dr., Holland, OH 43528 | 2020-01-10 |
| 1982262291 | Raven Diane Hannah | Licensed Vocational Nurse | 350 South Irwin Rd, Holland, OH 43528 | 2019-06-01 |
| 1881163988 | Brandon Scott Smith | Counselor | 350 S Irwin Road, Holland, OH 43528 | 2018-11-19 |
| 1184199432 | Pamela Adrienne Wilson | Rehabilitation Counselor | 350 S. Irwin Road, Holland, OH 43528 | 2018-10-12 |
| 1023509460 | Shaunte Harris | Counselor | 350 S Irwin, Holland, OH 43528 | 2018-05-22 |
| 1982193314 | William Floyd Johnson | Counselor | 350 S. Irwin, Holland, OH 43528 | 2018-05-01 |
| 1174025100 | Samantha Hoelzer | Optometrist | 1460 Spring Meadows Drive, E100, Holland, OH 43528 | 2018-03-06 |
| 1780186262 | Vicki Gottfried | Community/Behavioral Health | 7015 Spring Meadows West Drive Suite 102, Holland, OH 43528 | 2018-03-01 |
| 1922519859 | Shaunta Marie Grier | Licensed Practical Nurse | 350 S Irwin Street, Holland, OH 43528 | 2017-10-18 |
| Find all providers in zip 43528 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750765640 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 1951 Connecticut Blvd., Holland, OH 43528 | 2015-07-10 |
| 1477798502 | Anne Grady Corporation | Intermediate Care Facility, Mentally Retarded | 1601 Eber Rd, Holland, OH 43528-8213 | 2008-12-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164020616 | Viaquest Healthcare Central | Intermediate Care Facility, Mentally Retarded | 6873 Dave Dr, Madison, OH 44057-1105 | 2020-10-15 |
| 1366056210 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 410 Abbe Road, Sheffield Lake, OH 44054 | 2020-09-08 |
| 1619581568 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 460 Abbe Road, Sheffield Lake, OH 44054 | 2020-09-08 |
| 1548874589 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 448 Opportunity Way, Lagrange, OH 44050-9021 | 2020-09-08 |
| 1194339044 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 5230 East Lake Road, Sheffield Lake, OH 44054 | 2020-09-08 |
| 1326652496 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 801 Robinwood, Sheffield Lake, OH 44054 | 2020-09-04 |
| 1346854890 | Res-care Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 426 Opportunity Way, Lagrange, OH 44050-9021 | 2020-09-02 |
| 1144841438 | Wood Lane Residential Services | Intermediate Care Facility, Mentally Retarded | 355 W Main St., Portage, OH 43451-9802 | 2020-04-28 |
| 1689209009 | 333 Therapeutics Consulting LLC | Intermediate Care Facility, Mentally Retarded | 331 Toby Rd, Eaton, OH 45320-9529 | 2020-03-05 |
| 1700418258 | Jewish Family Service Association | Intermediate Care Facility, Mentally Retarded | 8132 Cedar Rd, Chesterland, OH 44026-3548 | 2020-02-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.