MR. LARRY J GRAHAM JR. (NPI# 1710528617) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1710528617 |
Entity Type | Individual |
Full Name | MR. LARRY J GRAHAM JR. |
Practice Address |
1284 Maurer Ave Pontiac MI 48342-1960 |
Mailing Address |
1225 E Big Beaver Rd Troy MI 48083-1905 |
Practice Telephone | 2482521427 |
Mailing Telephone | 2485248801 |
Mailing Fax Number | 2485248850 |
Enumeration Date | 2019-10-01 |
Last Update Date | 2019-10-01 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780784173 | Larry A. Graham | Psychiatry & Neurology | 551 Cincinnati-batavia Pk, Cincinnati, OH 45244 | 2006-09-25 |
1255999249 | Larry D Graham | Pharmacist | 1026 Radio Rd, Durant, OK 74701-2991 | 2019-06-04 |
1275930554 | Larry David Graham | Surgery | 434 4th St, Newport, TN 37821-3746 | 2014-12-02 |
1962798314 | Larry E Graham Jr. | Occupational Therapy Assistant | 820 Camelot Dr, Harlingen, TX 78550-8400 | 2011-06-23 |
1871694828 | Larry G Graham | Pathology | 5301 Virginia Way Ste 300, Brentwood, TN 37027-7542 | 2006-09-25 |
1669572178 | Larry Lloyd Graham | Dentist | 1050 Wishard Blvd, Rm. 4201, Indianapolis, IN 46202-2872 | 2006-09-24 |
1023090503 | Larry C Graham II | Radiology | 3600 E Harry St, Wichita, KS 67218-3713 | 2005-11-18 |
Street Address |
1284 MAURER AVE |
City | PONTIAC |
State | MI |
Zip Code | 48342-1960 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528589561 | Beloved Home Care LLC. | Home Health | 12 S Mill. St., Apt.314, Pontiac, MI 48342 | 2017-06-29 |
1518496942 | Boris Tkach | Student in an Organized Health Care Education/Training Program | 50 N. Perry, Pontiac, MI 48342 | 2017-06-08 |
1023547429 | Nicholas James Stepanski | Student in an Organized Health Care Education/Training Program | 50 N. Perry St., Pontiac, MI 48342 | 2017-06-08 |
1245769991 | Mecca House Corporation | Assisted Living Facility | 53 West Huron, Pontiac, MI 48342 | 2017-06-07 |
1134672868 | Shannon Blaine | Technician, Other | 103 Parkhurst Street, Pontiac, MI 48342 | 2016-07-29 |
1669819249 | Bonnie Ann Smith | Occupational Therapist | 60 Parkhurst Dr., Pontiac, MI 48342 | 2013-05-23 |
1205123361 | Mary Ellen Kenworthy | Emergency Medicine | 50 North Perry Street, Pontiac, MI 48342 | 2011-07-08 |
1740516343 | Nathima Habib Atchoo | Obstetrics & Gynecology | 90 West University, Gary Burnstein Community Health Clinic (free Clinic), Pontiac, MI 48342 | 2009-11-02 |
1881824233 | Sylvia Lyn Thompson | Physical Therapist | 900 Auburn Road, Pontiac, MI 48342 | 2009-07-20 |
1114154150 | Kyannah Toyann Anderson | Home Health | 175 S.edith St, Pontiac, MI 48342 | 2009-06-17 |
Find all providers in zip 48342 |
Taxonomy Code | 320800000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment Facility, Mental Illness |
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912434770 | Phoenix Residential Services | Community Based Residential Treatment Facility, Mental Illness | 108 Franklin Blvd, Pontiac, MI 48341-1706 | 2017-05-11 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083237051 | Twin Doves I LLC | Community Based Residential Treatment Facility, Mental Illness | 48617 36th Ave., Bangor, MI 49013 | 2020-05-25 |
1104452812 | New Vision of Integrative Services, Inc | Community Based Residential Treatment Facility, Mental Illness | 3505 Walnut St Ste C, Inkster, MI 48141-2952 | 2020-03-14 |
1124665054 | Baseline, L.L.C. | Community Based Residential Treatment Facility, Mental Illness | 122 W Crosstown Pkwy, Kalamazoo, MI 49001-2742 | 2019-12-10 |
1407491277 | Twin Doves II LLC | Community Based Residential Treatment Facility, Mental Illness | 40739 80th Ave, Decatur, MI 49045-8158 | 2019-11-15 |
1447815469 | Rainbow Rehabilitation Centers, Inc. | Community Based Residential Treatment Facility, Mental Illness | 6200 Textile Rd, Ypsilanti, MI 48197 | 2019-05-06 |
1669937603 | Community Living Options | Community Based Residential Treatment Facility, Mental Illness | 1206 Bronson Cir, Kalamazoo, MI 49008-2325 | 2019-02-04 |
1235607854 | Csm Serenity Homes, LLC | Community Based Residential Treatment Facility, Mental Illness | 1714 W 32nd St, Holland, MI 49423-7311 | 2018-11-13 |
1750859229 | The Noble Home II, Inc | Community Based Residential Treatment Facility, Mental Illness | 327 E Grand Blvd, Detroit, MI 48207-3616 | 2018-11-02 |
1679048870 | Neighborhood Living Services,inc. | Community Based Residential Treatment Facility, Mental Illness | 23001 Norfolk St, Detroit, MI 48219-1185 | 2018-10-04 |
1851875371 | People Community of Michigan Afc Homes, Inc. | Community Based Residential Treatment Facility, Mental Illness | 16829 Monica St, Detroit, MI 48221-2969 | 2018-09-20 |
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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.