Healthcare Provider Details

I. General information

NPI: 1992504252
Provider Name (Legal Business Name): GRANDI ENSEMBLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 CATON AVE
BROOKLYN NY
11226-8393
US

IV. Provider business mailing address

1182 E 35TH ST
BROOKLYN NY
11210-4231
US

V. Phone/Fax

Practice location:
  • Phone: 929-541-5711
  • Fax:
Mailing address:
  • Phone: 929-541-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JACQUES LAVENTURE
Title or Position: DIRECTOR
Credential:
Phone: 929-541-5711