Provider Demographics
NPI:1740988914
Name:GRANNY'S NANNIES LLC
Entity type:Organization
Organization Name:GRANNY'S NANNIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NORMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-415-3220
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-0672
Mailing Address - Country:US
Mailing Address - Phone:504-415-3220
Mailing Address - Fax:
Practice Address - Street 1:313 AVERY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-1211
Practice Address - Country:US
Practice Address - Phone:504-415-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care