Provider Demographics
NPI:1639870272
Name:GRANNY'S HOMES, INC.
Entity Type:Organization
Organization Name:GRANNY'S HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUINTIN JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAVECILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-244-5885
Mailing Address - Street 1:10212 MALINDA LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2918
Mailing Address - Country:US
Mailing Address - Phone:714-244-5885
Mailing Address - Fax:
Practice Address - Street 1:10212 MALINDA LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2918
Practice Address - Country:US
Practice Address - Phone:714-244-5885
Practice Address - Fax:714-583-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility