Provider Demographics
NPI:1871703702
Name:GRANTS PASS MANAGEMENT SERVICES, INC.
Entity type:Organization
Organization Name:GRANTS PASS MANAGEMENT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:541-787-4014
Mailing Address - Street 1:1867 WILLIAMS HIGHWAY SUITE 108
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-471-4207
Mailing Address - Fax:541-471-4898
Practice Address - Street 1:109 NE MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1400
Practice Address - Country:US
Practice Address - Phone:541-479-8847
Practice Address - Fax:541-471-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500600005Medicaid