Provider Demographics
NPI:1003457508
Name:GROAT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GROAT
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 1:2650 N GARNET LN
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-3414
Mailing Address - Country:US
Mailing Address - Phone:907-355-8677
Mailing Address - Fax:
Practice Address - Street 1:2650 N GARNET LN
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-3414
Practice Address - Country:US
Practice Address - Phone:907-355-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility