MEDICARE: GRAND GONAIVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	342000000X	Transportation Network Company
3	251G00000X	Community Based Hospice Care Agency
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1588474480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND GONAIVES

Provider Business Mailing Address
First Line	:	2115 W 94TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-6309
Country	:	US
Telephone Number	:	773-615-1638
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 W 94TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-6309
Country	:	US
Telephone Number	:	773-615-1638
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. YVES BIENVENU JR.
Credential	:
Telephone Number	:	773-615-1638

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	02/12/2026

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Directions to “GRAND GONAIVES ” Practice Location

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