Provider Demographics
NPI:1568179562
Name:GROVE LANE LLC
Entity Type:Organization
Organization Name:GROVE LANE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-777-8621
Mailing Address - Street 1:9107 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-5742
Mailing Address - Country:US
Mailing Address - Phone:281-777-8621
Mailing Address - Fax:888-757-8009
Practice Address - Street 1:9107 BRECKENRIDGE DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-5742
Practice Address - Country:US
Practice Address - Phone:281-777-8621
Practice Address - Fax:888-757-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies