Provider Demographics
NPI:1417521097
Name:AVIV GRAND JUNCTION, LLC
Entity Type:Organization
Organization Name:AVIV GRAND JUNCTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-8818
Mailing Address - Street 1:PO BOX 40186
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-0186
Mailing Address - Country:US
Mailing Address - Phone:970-241-8818
Mailing Address - Fax:
Practice Address - Street 1:514 28 1/4 RD UNIT 5
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4961
Practice Address - Country:US
Practice Address - Phone:970-241-8818
Practice Address - Fax:970-241-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health