Provider Demographics
NPI:1588474480
Name:GRAND GONAIVES
Entity type:Organization
Organization Name:GRAND GONAIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YVES
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENVENU
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:773-615-1638
Mailing Address - Street 1:2115 W 94TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-6309
Mailing Address - Country:US
Mailing Address - Phone:773-615-1638
Mailing Address - Fax:
Practice Address - Street 1:2115 W 94TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6309
Practice Address - Country:US
Practice Address - Phone:773-615-1638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No342000000XTransportation ServicesTransportation Network Company