Provider Demographics
NPI:1942476031
Name:GRAPEVINE HOMECARE INC
Entity Type:Organization
Organization Name:GRAPEVINE HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:G
Authorized Official - Last Name:AFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-389-8200
Mailing Address - Street 1:10523 BURBANK BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2239
Mailing Address - Country:US
Mailing Address - Phone:818-985-0888
Mailing Address - Fax:818-985-0889
Practice Address - Street 1:1007 E DOMINGUEZ ST STE P
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-7244
Practice Address - Country:US
Practice Address - Phone:213-389-8200
Practice Address - Fax:213-389-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059152Medicare Oscar/Certification