Provider Demographics
NPI:1831902261
Name:GROVE CARE CLINIC LLC
Entity type:Organization
Organization Name:GROVE CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-809-1021
Mailing Address - Street 1:PMB 342
Mailing Address - Street 2:1498 E MAIN ST STE 103
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424
Mailing Address - Country:US
Mailing Address - Phone:541-780-0037
Mailing Address - Fax:541-702-8784
Practice Address - Street 1:1601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2243
Practice Address - Country:US
Practice Address - Phone:541-780-0037
Practice Address - Fax:541-702-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care