Provider Demographics
NPI:1104236140
Name:GRISWOLD HOME CARE REGISTRY
Entity type:Organization
Organization Name:GRISWOLD HOME CARE REGISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-250-0418
Mailing Address - Street 1:520 SE COLUMBIA RIVER DR APT 316
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-8034
Mailing Address - Country:US
Mailing Address - Phone:503-250-0418
Mailing Address - Fax:
Practice Address - Street 1:520 SE COLUMBIA RIVER DR APT 316
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-8034
Practice Address - Country:US
Practice Address - Phone:503-250-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NELSON DEVELOPMENT COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2269253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care