Healthcare Provider Details

I. General information

NPI: 1497053581
Provider Name (Legal Business Name): GRINNELL HEALTH CARE INVESTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH AVE W
GRINNELL IA
50112-8236
US

IV. Provider business mailing address

415 6TH AVE W
GRINNELL IA
50112-8236
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-6511
  • Fax: 641-236-6713
Mailing address:
  • Phone: 641-236-6511
  • Fax: 641-236-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA RENE ROTH
Title or Position: CONTROLLER
Credential:
Phone: 317-557-1190