Provider Demographics
NPI:1639274103
Name:GRANDVIEW CARE CENTER INC
Entity Type:Organization
Organization Name:GRANDVIEW CARE CENTER INC
Other - Org Name:GRANDVIEW MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:816-415-9700
Mailing Address - Street 1:5301 HARRY TRUMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030
Mailing Address - Country:US
Mailing Address - Phone:816-763-2855
Mailing Address - Fax:816-761-8763
Practice Address - Street 1:5301 HARRY TRUMAN DRIVE
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030
Practice Address - Country:US
Practice Address - Phone:816-763-2855
Practice Address - Fax:816-761-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO016196314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108470808Medicaid
265686Medicare Oscar/Certification