MEDICARE: DEBRA GRANT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	LIC# 19394	CA

General Provider Information

NPI Number	:	1932438504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA GRANT

Provider Business Mailing Address
First Line	:	91 VALLEY VIEW DR
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-1039
Country	:	US
Telephone Number	:	707-795-4929
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 VALLEY VIEW DR
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-1039
Country	:	US
Telephone Number	:	707-793-2133
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MS. DEBRA GRANT
Credential	:
Telephone Number	:	707-793-2133

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	12/10/2009

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Directions to “DEBRA GRANT ” Practice Location

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