Provider Demographics
NPI:1881083590
Name:GRANDEE VILLAGE HOME HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:GRANDEE VILLAGE HOME HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:SINJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-755-0296
Mailing Address - Street 1:3712 S GOLDEN GRAIN CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-3393
Mailing Address - Country:US
Mailing Address - Phone:801-755-0296
Mailing Address - Fax:
Practice Address - Street 1:3712 S GOLDEN GRAIN CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3393
Practice Address - Country:US
Practice Address - Phone:801-755-0296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health