Provider Demographics
NPI:1255125159
Name:JP GRAND HEARTS HEALTHCARE
Entity type:Organization
Organization Name:JP GRAND HEARTS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-615-7063
Mailing Address - Street 1:707 GITTINGS ST STE 100L
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6156
Mailing Address - Country:US
Mailing Address - Phone:757-615-7063
Mailing Address - Fax:
Practice Address - Street 1:707 GITTINGS ST STE 100L
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6156
Practice Address - Country:US
Practice Address - Phone:757-615-7063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty