MR. LARRY J GRAHAM JR.


Address: 1284 Maurer Ave, Pontiac, MI 48342-1960
Phone: 2482521427

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320800000X Community Based Residential Treatment Facility, Mental Illness Residential Treatment Facilities

Other Providers LARRY GRAHAM

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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

Office Location

Street Address 1284 MAURER AVE
City PONTIAC
State MI
Zip Code 48342-1960

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 320800000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment Facility, Mental Illness

Taxonomy Definition

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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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Competitor

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City PONTIAC
Zip Code 48342

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Dataset Information

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.

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