Provider Demographics
NPI:1417305871
Name:GRISWOLD INTERNATIONAL, LLC
Entity Type:Organization
Organization Name:GRISWOLD INTERNATIONAL, LLC
Other - Org Name:GRISWOLD HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF QUALITY AND COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:215-437-0363
Mailing Address - Street 1:120 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1420
Mailing Address - Country:US
Mailing Address - Phone:215-403-7036
Mailing Address - Fax:215-402-0202
Practice Address - Street 1:3525 ELLICOTT MILLS DR
Practice Address - Street 2:SUITE G
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4547
Practice Address - Country:US
Practice Address - Phone:410-988-2634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRISWOLD INTERNATIONAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNR#090601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care