| Organization Name: | GRADEN PROVISION OF PROMISE OUTREACH ORG |
| NPI Number: | 1164795449 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIE WALTER SMITH (CEO) |
| Mailing Address: | 2421 Sheridan Ave Saginaw |
| State: | MI US |
| Postal Code: | 486013613 |
| Phone Number: | 9897535477 |
| Fax Number: | 9897537461 |
| NPI Enumeration Date: | 02/16/2012 |
| NPI Last Update Date: | 02/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171M00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Case Manager/Care Coordinator |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee |