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General NPI Number Information
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NPI Number | 1649076787
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Entity Type | Organization
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Legal Business Name | FOUR GRAINS GROUP
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | CARR. 723 KM 0.8 BO. ASOMANTE
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City | AIBONITO
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State | PR
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Zip | 00705
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Country | US
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Telephone | 939-425-0052
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 AVE JOSE ZAYAS GRN APT D3
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City | BARRANQUITAS
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State | PR
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Zip | 00794-2031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. IVAN RODRIGUEZ
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Credential |
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Telephone | 787-516-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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