Provider Demographics
NPI:1841650637
Name:CONNIE GRUBBS
Entity type:Organization
Organization Name:CONNIE GRUBBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-223-7833
Mailing Address - Street 1:17605 COLD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-8896
Mailing Address - Country:US
Mailing Address - Phone:775-223-7833
Mailing Address - Fax:
Practice Address - Street 1:17605 COLD SPRINGS DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89508-8896
Practice Address - Country:US
Practice Address - Phone:775-223-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV900504892Medicaid