Provider Demographics
NPI:1578989695
Name:GRANDVIEW RETIREMENT CENTER
Entity Type:Organization
Organization Name:GRANDVIEW RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:MAULDEN
Authorized Official - Last Name:WILLIAMS-NOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-477-4929
Mailing Address - Street 1:1706 E OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7553
Mailing Address - Country:US
Mailing Address - Phone:850-477-4929
Mailing Address - Fax:850-477-9659
Practice Address - Street 1:1706 E OLIVE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7553
Practice Address - Country:US
Practice Address - Phone:850-477-4929
Practice Address - Fax:850-477-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7371310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility