Doctor Name: | MR. ROSS STANLEY GRIMAUD |
NPI Number: | 1366648578 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 3865 |
Business Practice Address: | 5699 S Mountain Side Ln Hereford, AZ - 856158810 |
Business Phone Number: | 5208039093 |
Business Fax Number: | |
Mailing Address: | 5699 S Mountain Side Ln, HEREFORD |
State: | AZ |
Postal Code: | 856158810 |
Phone Number: | 5208039093 |
Fax Number: | |
NPI Enumeration Date: | 06/25/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385HR2055X |
License Number: | 3865 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | Respite Care, Mental Illness, Child |
Taxonomy Definition: | A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers. |