Healthcare Provider Details

I. General information

NPI: 1740278282
Provider Name (Legal Business Name): GRAND MEADOW HEALTHCARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GRAND AVE W
GRAND MEADOW MN
55936-1105
US

IV. Provider business mailing address

210 GRAND AVE W PO BOX 365
GRAND MEADOW MN
55936-1105
US

V. Phone/Fax

Practice location:
  • Phone: 507-754-5226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number326959
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0029853
License Number StateMN

VIII. Authorized Official

Name: HOWIE GROFF
Title or Position: PRESIDENT
Credential:
Phone: 952-888-2923