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Susan Genevieve Gray
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Costa Mesa, California
NPI 1083306948

Susan Genevieve Gray is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Long Beach, CA. Susan Genevieve Gray practices in Costa Mesa, CA. The NPI Number for Susan Genevieve Gray is 1083306948 and holds a License No. (California).

The current practice location address for Susan Genevieve Gray is 3186 Airway Ave, Costa Mesa, CA and can be reached out via phone at 469-938-9987.

Location: 3186 Airway Ave, Costa Mesa, CA, 90805-1411
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1083306948
Provider Name
Susan Genevieve Gray
Credential
Provider Entity Type
Individual
Gender
Female
Address
3186 Airway Ave, Costa Mesa, CA, 90805-1411
Phone Number
469-938-9987
Fax Number
Provider Enumeration Date
05/22/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3186 Airway Ave
City
Costa Mesa
State
California
Zip
92626-4650
Phone Number
469-938-9987
Fax Number
person
Provider Business Mailing Address Details
Address
3186 Airway Ave
City
Costa Mesa
State
California
Zip
92626-4650
Phone Number
469-938-9987
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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