Provider Demographics
NPI:1386032837
Name:GRANVILLE AID OPCO LLC
Entity Type:Organization
Organization Name:GRANVILLE AID OPCO LLC
Other - Org Name:GRANVILLE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-725-7072
Mailing Address - Street 1:330 N WABASH AVE STE 3700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7605
Mailing Address - Country:US
Mailing Address - Phone:312-725-7072
Mailing Address - Fax:
Practice Address - Street 1:111 SUNSET RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4159
Practice Address - Country:US
Practice Address - Phone:312-725-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10A000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility