Healthcare Provider Details

I. General information

NPI: 1740887132
Provider Name (Legal Business Name): GRAND VIEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 S WASHINGTON ST
GRAND FORKS ND
58201-7222
US

IV. Provider business mailing address

4650 S WASHINGTON ST
GRAND FORKS ND
58201-7222
US

V. Phone/Fax

Practice location:
  • Phone: 701-772-3400
  • Fax:
Mailing address:
  • Phone: 701-772-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD MICHAEL OLSON
Title or Position: CFO
Credential:
Phone: 701-852-7700