Provider Demographics
NPI:1245061910
Name:GRASSROOTS GROUNDWORK L.L.C.
Entity type:Organization
Organization Name:GRASSROOTS GROUNDWORK L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:KANOUS
Authorized Official - Suffix:
Authorized Official - Credentials:CCHW
Authorized Official - Phone:517-285-6390
Mailing Address - Street 1:1860 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3730
Mailing Address - Country:US
Mailing Address - Phone:517-285-6390
Mailing Address - Fax:
Practice Address - Street 1:1860 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3730
Practice Address - Country:US
Practice Address - Phone:517-285-6390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty