Provider Demographics
NPI:1417058447
Name:GRANDMAR INC
Entity Type:Organization
Organization Name:GRANDMAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-895-0441
Mailing Address - Street 1:15079 WICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6621
Mailing Address - Country:US
Mailing Address - Phone:510-895-0441
Mailing Address - Fax:510-895-0448
Practice Address - Street 1:15079 WICKS BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-6621
Practice Address - Country:US
Practice Address - Phone:510-895-0441
Practice Address - Fax:510-895-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0271670001Medicare ID - Type Unspecified