Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health (Including Community Mental Health Center) |
261QM0801X | B4[14] | Community Mental Health Center |
| NPI Number | 1609249390 |
| LBN Legal business name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Authorized official | LARRY SMITH - (CEO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 11/04/2015 |
| Last updated | 07/31/2020 - About 6 years ago |
| Identifiers | n/a |
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