Provider Demographics
NPI:1740043223
Name:GRAND CARE ASSISTED LIVING
Entity type:Organization
Organization Name:GRAND CARE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETA
Authorized Official - Middle Name:GEDION
Authorized Official - Last Name:GIRSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-302-6559
Mailing Address - Street 1:1405 CROSSINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6253
Mailing Address - Country:US
Mailing Address - Phone:574-302-6559
Mailing Address - Fax:
Practice Address - Street 1:1405 CROSSINGS PKWY
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6253
Practice Address - Country:US
Practice Address - Phone:574-302-6559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility