Provider Demographics
NPI:1518928282
Name:GRANDMAS CARE HOME INC
Entity Type:Organization
Organization Name:GRANDMAS CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-362-9800
Mailing Address - Street 1:PO BOX 191037
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1037
Mailing Address - Country:US
Mailing Address - Phone:208-362-9800
Mailing Address - Fax:208-362-9802
Practice Address - Street 1:8418 WEST LAJOLLA STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5194
Practice Address - Country:US
Practice Address - Phone:208-362-9800
Practice Address - Fax:208-362-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC844310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility