Healthcare Provider Details

I. General information

NPI: 1235838277
Provider Name (Legal Business Name): GRANDMOTHERHOME&CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB.MONTE CARLOS 1265
SAN JUAN PR
00924-2336
US

IV. Provider business mailing address

PO BOX 30347
SAN JUAN PR
00929-1347
US

V. Phone/Fax

Practice location:
  • Phone: 787-979-6747
  • Fax:
Mailing address:
  • Phone: 787-979-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GIOVANNI SALERNO
Title or Position: OWNER
Credential: MD
Phone: 787-979-6747