Provider Demographics
NPI:1841304755
Name:ASPIRUS GRAND VIEW SERVICE CORPORATION
Entity type:Organization
Organization Name:ASPIRUS GRAND VIEW SERVICE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIANTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-932-2525
Mailing Address - Street 1:N10565 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1500
Mailing Address - Fax:
Practice Address - Street 1:501 GRANITE ST
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1372
Practice Address - Country:US
Practice Address - Phone:715-561-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41735200Medicaid
WI41735200Medicaid