Healthcare Provider Details

I. General information

NPI: 1528854791
Provider Name (Legal Business Name): ANTOINETTE MORRIS GRAND CGFM, PMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6958 KETCHUM DR
COLORADO SPRINGS CO
80911-9406
US

IV. Provider business mailing address

5755 KITTERY DR # 31301
COLORADO SPRINGS CO
80911-3529
US

V. Phone/Fax

Practice location:
  • Phone: 317-801-1493
  • Fax:
Mailing address:
  • Phone: 719-679-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: