Provider Demographics
NPI:1285321471
Name:MY GRANDPARENTS PLACE
Entity type:Organization
Organization Name:MY GRANDPARENTS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-482-0400
Mailing Address - Street 1:8748 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-7205
Mailing Address - Country:US
Mailing Address - Phone:214-482-0400
Mailing Address - Fax:
Practice Address - Street 1:8748 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-7205
Practice Address - Country:US
Practice Address - Phone:214-482-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty