Healthcare Provider Details

I. General information

NPI: 1942476031
Provider Name (Legal Business Name): GRAPEVINE HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 E DOMINGUEZ ST STE P
CARSON CA
90746-7244
US

IV. Provider business mailing address

10523 BURBANK BLVD STE 215
NORTH HOLLYWOOD CA
91601-2239
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-8200
  • Fax: 213-389-8201
Mailing address:
  • Phone: 818-985-0888
  • Fax: 818-985-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VILMA G AFANTE
Title or Position: COO
Credential:
Phone: 213-389-8200