Healthcare Provider Details

I. General information

NPI: 1770544934
Provider Name (Legal Business Name): GRAND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 GRAND AVE
AMES IA
50010-4125
US

IV. Provider business mailing address

3440 GRAND AVE
AMES IA
50010-4125
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-3426
  • Fax: 515-232-8313
Mailing address:
  • Phone: 515-232-3426
  • Fax: 515-232-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number850636
License Number StateIA

VIII. Authorized Official

Name: MICHELLE ZIMBELMAN
Title or Position: MANAGER
Credential:
Phone: 816-232-9573