Provider Demographics
NPI:1972805679
Name:GRAND CANYON HOME CARE INC.
Entity type:Organization
Organization Name:GRAND CANYON HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSHUVAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-864-3328
Mailing Address - Street 1:13201 N 35TH AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1231
Mailing Address - Country:US
Mailing Address - Phone:602-795-0222
Mailing Address - Fax:602-795-0080
Practice Address - Street 1:13201 N 35TH AVE STE 1B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1231
Practice Address - Country:US
Practice Address - Phone:602-795-0222
Practice Address - Fax:602-795-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty