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General NPI Number Information
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NPI Number | 1174704266
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Entity Type | Organization
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Legal Business Name | GRAND AMERICAN HOME CARE, INC.
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Dates
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Enumeration Date | 11/17/2007
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 21649 GODDARD RD SUITE B-125
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City | TAYLOR
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State | MI
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Zip | 48180-4299
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Country | US
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Telephone | 313-292-3529
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Fax | 313-292-3787
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Provider Business Mailing Address
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Address Line | 21649 GODDARD RD SUITE B-125
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City | TAYLOR
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State | MI
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Zip | 48180-4299
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Country | US
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Telephone | 313-292-3529
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Fax | 313-292-3787
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AUGUSTINE R DOMINGO JR.
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Credential |
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Telephone | 313-292-3529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | MI
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