Provider Demographics
NPI:1992967988
Name:GRANTHAN, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GRANTHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:ARIVACA
Mailing Address - State:AZ
Mailing Address - Zip Code:85601-0264
Mailing Address - Country:US
Mailing Address - Phone:520-398-9151
Mailing Address - Fax:
Practice Address - Street 1:14500 CROOKED SKYA
Practice Address - Street 2:
Practice Address - City:ARIVACA
Practice Address - State:AZ
Practice Address - Zip Code:85601-0264
Practice Address - Country:US
Practice Address - Phone:520-398-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8637385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child