=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396086773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANNIES & GRAMPS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2013
-----------------------------------------------------
Last Update Date | 03/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2429 BISSONNET ST SUITE 490
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77005-1451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-400-6027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2429 BISSONNET ST SUITE 490
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77005-1451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-400-6027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. LEAH DAYNON KIRKWOOD
-----------------------------------------------------
Credential | MIBA
-----------------------------------------------------
Telephone | 602-400-6027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------