Provider Demographics
NPI:1255157988
Name:ZIWU-GRUNITZKY, VIDA
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:ZIWU-GRUNITZKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MARY GAY CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2904
Mailing Address - Country:US
Mailing Address - Phone:718-395-0830
Mailing Address - Fax:
Practice Address - Street 1:117 MARY GAY CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2904
Practice Address - Country:US
Practice Address - Phone:718-395-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA307726251E00000X, 253Z00000X, 314000000X, 372600000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No372600000XNursing Service Related ProvidersAdult Companion