Healthcare Provider Details

I. General information

NPI: 1861663247
Provider Name (Legal Business Name): 81 GRAND HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 MCHENRY AVE
MODESTO CA
95350-4528
US

IV. Provider business mailing address

1539 MCHENRY AVE
MODESTO CA
95350-4528
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-3290
  • Fax: 209-550-4944
Mailing address:
  • Phone: 209-578-3290
  • Fax: 209-550-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFERY J STECKLER
Title or Position: OWNER
Credential: COTA
Phone: 209-578-3290