Provider Demographics
NPI:1184014169
Name:GRANDCARE HOSPICE SERVICES LLC
Entity Type:Organization
Organization Name:GRANDCARE HOSPICE SERVICES LLC
Other - Org Name:GRANDCARE HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:877-889-8570
Mailing Address - Street 1:2555 E COLORADO BLVD
Mailing Address - Street 2:SUITE 400-B
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6622
Mailing Address - Country:US
Mailing Address - Phone:877-889-8570
Mailing Address - Fax:855-897-7785
Practice Address - Street 1:2555 E COLORADO BLVD
Practice Address - Street 2:SUITE 400-B
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6622
Practice Address - Country:US
Practice Address - Phone:877-889-8570
Practice Address - Fax:855-897-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001379251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based