Provider Demographics
NPI:1750331955
Name:GRAND HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:GRAND HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-413-6750
Mailing Address - Street 1:7435 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3330
Mailing Address - Country:US
Mailing Address - Phone:773-413-6750
Mailing Address - Fax:773-413-6756
Practice Address - Street 1:7435 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3330
Practice Address - Country:US
Practice Address - Phone:773-413-6750
Practice Address - Fax:773-413-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1009794251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL217035OtherMEDICARE PART B
IL5085OtherBLUE CROSS BLUE SHIELD
IL217035OtherMEDICARE PART B
IL5085OtherBLUE CROSS BLUE SHIELD