1235763624 NPI number — GRAND COMPANIONS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235763624 NPI number — GRAND COMPANIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND COMPANIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SYNERGY HOMECARE EAST CENTRAL METRO AND WEST CENTRAL WI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235763624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 BIELENBERG DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55125-2620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-256-2214
Provider Business Mailing Address Fax Number:
651-413-3000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2155 WOODLANE DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-256-2214
Provider Business Practice Location Address Fax Number:
651-829-2368
Provider Enumeration Date:
02/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HARMON
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-256-2214

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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