Provider Demographics
NPI:1043217243
Name:GRANDVIEW HEALTH HOMES, INC.
Entity Type:Organization
Organization Name:GRANDVIEW HEALTH HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:570-275-5240
Mailing Address - Street 1:49 WOODBINE LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8022
Mailing Address - Country:US
Mailing Address - Phone:570-275-5240
Mailing Address - Fax:570-275-3104
Practice Address - Street 1:49 WOODBINE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8022
Practice Address - Country:US
Practice Address - Phone:570-275-5240
Practice Address - Fax:570-275-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA591602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00755375Medicaid
PA591602OtherSTATE LICENSE
PA395623Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER