Provider Demographics
NPI:1396465654
Name:GRANDVIEW RESTHOME ASSN
Entity type:Organization
Organization Name:GRANDVIEW RESTHOME ASSN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-866-3367
Mailing Address - Street 1:301 W CRINER ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-1819
Mailing Address - Country:US
Mailing Address - Phone:817-866-3367
Mailing Address - Fax:817-866-3771
Practice Address - Street 1:301 W CRINER ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050-1819
Practice Address - Country:US
Practice Address - Phone:817-866-3367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care