Provider Demographics
NPI:1669645230
Name:GRAND VALLEY SENIOR DAYBREAK INC
Entity Type:Organization
Organization Name:GRAND VALLEY SENIOR DAYBREAK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-7798
Mailing Address - Street 1:599 30 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5658
Mailing Address - Country:US
Mailing Address - Phone:970-241-7798
Mailing Address - Fax:970-241-7798
Practice Address - Street 1:599 30 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5658
Practice Address - Country:US
Practice Address - Phone:970-241-7798
Practice Address - Fax:970-241-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04140992Medicaid