Provider Demographics
NPI:1346083854
Name:GRAND VALLEY PRO CLEAN LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:GRAND VALLEY PRO CLEAN LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-783-8247
Mailing Address - Street 1:499 CORONADO CT UNIT C
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7628
Mailing Address - Country:US
Mailing Address - Phone:970-783-8247
Mailing Address - Fax:
Practice Address - Street 1:499 CORONADO CT UNIT C
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7628
Practice Address - Country:US
Practice Address - Phone:970-783-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home