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General NPI Number Information
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NPI Number | 1629335773
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Entity Type | Organization
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Legal Business Name | GRANDWOOD ASSISTED LIVING, LC
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 2001 SUNRISE BLVD
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City | GROVE
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State | OK
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Zip | 74344-3617
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Country | US
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Telephone | 918-787-2011
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Fax | 918-787-2077
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Provider Business Mailing Address
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Address Line | 2001 SUNRISE BLVD
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City | GROVE
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State | OK
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Zip | 74344-3617
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Country | US
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Telephone | 918-787-2011
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Fax | 918-787-2077
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Authorized Official
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Title or Position | OWNER
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Name | MARY YOUNT
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Credential |
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Telephone | 918-787-2011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL2103-2103
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License Number State | OK
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