Susan Genevieve Gray

Individual provider Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · NPI 1083306948

Susan Genevieve Gray is an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Costa Mesa, California. Practices as a sole proprietor. Registered with an NPI since 2023.

In the registry since: 2023

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Practice location Address checks out

3186 Airway Ave
Costa Mesa, CA 92626-4650
Phone: (469) 938-9987

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Specialties & licences

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary)	Taxonomy 320900000X

Record details

NPI number	1083306948
Entity type	Individual (Type 1)
Gender	Female
Sole proprietor	Yes
NPI enumerated	May 22, 2023
Last updated in NPPES	May 22, 2023
Certification date	May 20, 2023