Provider Demographics
NPI:1114324605
Name:GRINNELL HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:GRINNELL HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-588-7518
Mailing Address - Street 1:211 N BROADWAY STE 2035
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63102-2727
Mailing Address - Country:US
Mailing Address - Phone:314-588-7518
Mailing Address - Fax:
Practice Address - Street 1:415 S 6TH STREET
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112
Practice Address - Country:US
Practice Address - Phone:641-236-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA790312314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA800058Medicaid
IA800058Medicaid