Provider Demographics
NPI:1194180505
Name:GOLDEN GRAND HOME CARE LLC
Entity Type:Organization
Organization Name:GOLDEN GRAND HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEWIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GHEBREZGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-442-0622
Mailing Address - Street 1:18036 DUNCAN CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7244
Mailing Address - Country:US
Mailing Address - Phone:651-333-9504
Mailing Address - Fax:651-344-8392
Practice Address - Street 1:18036 DUNCAN CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7244
Practice Address - Country:US
Practice Address - Phone:651-333-9504
Practice Address - Fax:651-344-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility