Provider Demographics
NPI:1215591722
Name:GRANDVIEW CARE LLC
Entity Type:Organization
Organization Name:GRANDVIEW CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:ASSISTED LIVING MNGR
Authorized Official - Phone:602-368-4468
Mailing Address - Street 1:8465 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8102
Mailing Address - Country:US
Mailing Address - Phone:602-812-9539
Mailing Address - Fax:
Practice Address - Street 1:4023 W GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2732
Practice Address - Country:US
Practice Address - Phone:602-368-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ467745Medicaid