Provider Demographics
NPI:1881473098
Name:GRANDIS CARE SERVICES
Entity type:Organization
Organization Name:GRANDIS CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:STK
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-423-3590
Mailing Address - Street 1:4033 DOVE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1959
Mailing Address - Country:US
Mailing Address - Phone:714-423-3590
Mailing Address - Fax:
Practice Address - Street 1:4033 DOVE ST APT 11
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1959
Practice Address - Country:US
Practice Address - Phone:714-423-3590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health