Provider Demographics
NPI:1548930670
Name:GRAND RISING MENTAL HEALTH SERVICE
Entity type:Organization
Organization Name:GRAND RISING MENTAL HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:216-632-3533
Mailing Address - Street 1:16201 JUDSON DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2159
Mailing Address - Country:US
Mailing Address - Phone:216-632-3533
Mailing Address - Fax:
Practice Address - Street 1:16802 LIPTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3620
Practice Address - Country:US
Practice Address - Phone:216-632-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health