Provider Demographics
NPI:1750389920
Name:GRANDVIEW RESTHOME ASSOCIATION
Entity type:Organization
Organization Name:GRANDVIEW RESTHOME ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-866-3367
Mailing Address - Street 1:301 W CRINER
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050
Mailing Address - Country:US
Mailing Address - Phone:817-866-3367
Mailing Address - Fax:817-866-3771
Practice Address - Street 1:301 W CRINER
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050
Practice Address - Country:US
Practice Address - Phone:817-866-3367
Practice Address - Fax:817-866-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
TX108808314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5160Medicaid
TX000516001Medicaid