Provider Demographics
NPI:1538275953
Name:ASPIRUS GRAND VIEW
Entity type:Organization
Organization Name:ASPIRUS GRAND VIEW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIANTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-932-2525
Mailing Address - Street 1:N10567 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-2440
Mailing Address - Fax:906-932-9772
Practice Address - Street 1:N10567 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-2440
Practice Address - Fax:906-932-9772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRUS GRAND VIEW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41531800Medicaid
MI3094708Medicaid
MIOE072OtherBCBS PROVIDER NUMBER
MI23D0382407OtherCLIA NUMBER
MIOE072OtherBCBS PROVIDER NUMBER