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General NPI Number Information
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NPI Number | 1104236140
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Entity Type | Organization
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Legal Business Name | GRISWOLD HOME CARE REGISTRY
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 520 SE COLUMBIA RIVER DR APT 316
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City | VANCOUVER
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State | WA
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Zip | 98661-8034
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Country | US
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Telephone | 503-250-0418
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Fax |
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Provider Business Mailing Address
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Address Line | 520 SE COLUMBIA RIVER DR APT 316
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City | VANCOUVER
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State | WA
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Zip | 98661-8034
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Country | US
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Telephone | 503-250-0418
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MISS DAVID ALLEN NELSON
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Credential |
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Telephone | 503-250-0418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 15-2269
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License Number State | OR
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