Provider Demographics
NPI:1295276772
Name:GRANBY LEASING CO., LLC
Entity type:Organization
Organization Name:GRANBY LEASING CO., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-530-1613
Mailing Address - Street 1:8575 N GRANBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1235
Mailing Address - Country:US
Mailing Address - Phone:816-436-8575
Mailing Address - Fax:816-436-0585
Practice Address - Street 1:8575 N GRANBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1235
Practice Address - Country:US
Practice Address - Phone:816-436-8575
Practice Address - Fax:816-436-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility