Provider Demographics
NPI:1003670522
Name:GRAJON HEALTHCARE LLC
Entity Type:Organization
Organization Name:GRAJON HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:IZEKOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-304-8687
Mailing Address - Street 1:13407 PEACH ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3234
Mailing Address - Country:US
Mailing Address - Phone:617-304-8687
Mailing Address - Fax:
Practice Address - Street 1:13407 PEACH ORCHARD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3234
Practice Address - Country:US
Practice Address - Phone:617-304-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health