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General NPI Number Information
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NPI Number | 1588474480
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Entity Type | Organization
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Legal Business Name | GRAND GONAIVES
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 2115 W 94TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-6309
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Country | US
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Telephone | 773-615-1638
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Fax |
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Provider Business Mailing Address
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Address Line | 2115 W 94TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-6309
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Country | US
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Telephone | 773-615-1638
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. YVES BIENVENU JR.
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Credential |
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Telephone | 773-615-1638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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