Provider Demographics
NPI:1477991735
Name:GRANADA 1 CORP.
Entity type:Organization
Organization Name:GRANADA 1 CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION SERVICE PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:AVENDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-676-5878
Mailing Address - Street 1:6712 YELLOWSTONE BLVD APT A19
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2329
Mailing Address - Country:US
Mailing Address - Phone:917-676-5878
Mailing Address - Fax:
Practice Address - Street 1:6712 YELLOWSTONE BLVD APT A19
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2329
Practice Address - Country:US
Practice Address - Phone:917-676-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty