Provider Demographics
NPI:1437735255
Name:GRANEPPS LLC
Entity Type:Organization
Organization Name:GRANEPPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRANADOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-427-4537
Mailing Address - Street 1:5220 WELCH VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-5249
Mailing Address - Country:US
Mailing Address - Phone:702-427-4537
Mailing Address - Fax:
Practice Address - Street 1:5220 WELCH VALLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-5249
Practice Address - Country:US
Practice Address - Phone:702-427-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty