Provider Demographics
NPI:1720413198
Name:GRANDE, INC.
Entity Type:Organization
Organization Name:GRANDE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-257-1303
Mailing Address - Street 1:1493 N MONTEBELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2586
Mailing Address - Country:US
Mailing Address - Phone:626-257-1303
Mailing Address - Fax:
Practice Address - Street 1:1493 N MONTEBELLO BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2586
Practice Address - Country:US
Practice Address - Phone:626-257-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3596002OtherCORPORATION NUMBER