1659372977 NPI number — GRAND VIEW CARE CENTER INC

Table of content: (NPI 1659372977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659372977 NPI number — GRAND VIEW CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND VIEW CARE CENTER INC
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:
Provider Other Organization Name Type Code:
6
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:
1659372977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAIR
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54616-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-989-2511
Provider Business Mailing Address Fax Number:
608-989-2679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 GRAND VIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAIR
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-989-2511
Provider Business Practice Location Address Fax Number:
608-989-2679
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEELE
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
KATHERINE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
608-989-2511

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 2893 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20120900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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