Provider Demographics
NPI:1568148476
Name:CG2, LLC
Entity Type:Organization
Organization Name:CG2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GRANDELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-886-0475
Mailing Address - Street 1:11773 FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-6681
Mailing Address - Country:US
Mailing Address - Phone:831-886-0475
Mailing Address - Fax:831-855-0157
Practice Address - Street 1:1815-D CONTRA COSTA
Practice Address - Street 2:
Practice Address - City:SAND CITY
Practice Address - State:CA
Practice Address - Zip Code:93955
Practice Address - Country:US
Practice Address - Phone:831-886-0475
Practice Address - Fax:831-855-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care