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General NPI Number Information
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NPI Number | 1194931857
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Entity Type | Organization
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Legal Business Name | GRAND VIEW CARE LODGE
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 647 ROUND HILL DR
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-1438
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Country | US
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Telephone | 970-241-8896
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Fax | 970-241-8799
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Provider Business Mailing Address
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Address Line | 647 ROUND HILL DR
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-1438
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Country | US
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Telephone | 970-241-8896
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Fax | 970-241-8799
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KORENE M. EWING
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Credential |
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Telephone | 970-241-8896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | CO
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