Graden Provision of Promise Outreach Org

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Legal business name

GRADEN PROVISION OF PROMISE OUTREACH ORG

Practice address

2421 Sheridan Ave
Saginaw, MI 48601-3613

Phone

(989) 753-5477

Fax

(989) 753-7461

NPI assigned

Feb 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Willie Walter Smith Jr.

Title

Ceo

Phone

(989) 753-5477

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1164795449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 SHERIDAN AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486013613",
            "telephone_number": "989-753-5477",
            "fax_number": "989-753-7461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 SHERIDAN AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486013613",
            "telephone_number": "989-753-5477",
            "fax_number": "989-753-7461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADEN PROVISION OF PROMISE OUTREACH ORG",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-753-5477",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakshmi Gowda Hanumaiah, MD
• Maryellene Grace, RPH
• Summer Grace, D.O.
• Katherine Helene Gracer, BSW, MSP
• Graciela Rico
• Megan Grady
• Joshua Graebner
• Ryan Jacob Graff
• Amy Marie Graham
• Ann Graham, CNM

• Case Manager/Care Coordinator in Saginaw, MI
• Providers in Saginaw, MI by specialty
• Case Manager/Care Coordinator in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.