Healthcare Provider Details

I. General information

NPI: 1114324605
Provider Name (Legal Business Name): GRINNELL HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S 6TH STREET
GRINNELL IA
50112
US

IV. Provider business mailing address

211 N BROADWAY STE 2035
SAINT LOUIS MO
63102-2727
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-6511
  • Fax:
Mailing address:
  • Phone: 314-588-7518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number790312
License Number StateIA

VIII. Authorized Official

Name: MR. MOSHE ORLINSKY
Title or Position: CEO
Credential:
Phone: 314-588-7518