Provider Demographics
NPI:1306415849
Name:GRAND B1
Entity Type:Organization
Organization Name:GRAND B1
Other - Org Name:GRATEFUL HEARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:AFC
Authorized Official - Phone:231-354-6564
Mailing Address - Street 1:11400 CORAL RD
Mailing Address - Street 2:
Mailing Address - City:CORAL
Mailing Address - State:MI
Mailing Address - Zip Code:49322-9649
Mailing Address - Country:US
Mailing Address - Phone:231-354-6564
Mailing Address - Fax:
Practice Address - Street 1:6523 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-9726
Practice Address - Country:US
Practice Address - Phone:231-354-6564
Practice Address - Fax:231-354-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-19
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home