Provider Demographics
NPI:1912521519
Name:GRANDEUR CARE HOSPICE LLC
Entity Type:Organization
Organization Name:GRANDEUR CARE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-487-9896
Mailing Address - Street 1:142 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4228
Mailing Address - Country:US
Mailing Address - Phone:951-487-9896
Mailing Address - Fax:888-671-6434
Practice Address - Street 1:142 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4228
Practice Address - Country:US
Practice Address - Phone:951-487-9896
Practice Address - Fax:888-671-6434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based