Provider Demographics
NPI:1811162977
Name:GRELL ENTERPRISES, INC.
Entity type:Organization
Organization Name:GRELL ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHRISLER
Authorized Official - Last Name:ELLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-718-0093
Mailing Address - Street 1:3249 NEWGATE CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2223
Mailing Address - Country:US
Mailing Address - Phone:614-718-0093
Mailing Address - Fax:614-718-0086
Practice Address - Street 1:1117 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3787
Practice Address - Country:US
Practice Address - Phone:407-892-3831
Practice Address - Fax:407-892-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL2453104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140932800Medicaid