MEDICARE: GROVE DEVELOPMENT OPERATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1043088024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVE DEVELOPMENT OPERATIONS LLC

Provider Business Mailing Address
First Line	:	16404 NE 127TH ST
Second Line	:
City	:	KEARNEY
State	:	MO
Zip	:	64060-8969
Country	:	US
Telephone Number	:	208-371-0158
Fax Number	:

Provider Business Practice Location Address
First Line	:	17996 BUSINESS 13
Second Line	:
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-9663
Country	:	US
Telephone Number	:	417-272-6666
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VANCE EARL FAGER
Credential	:
Telephone Number	:	208-371-0158

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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Directions to “GROVE DEVELOPMENT OPERATIONS LLC ” Practice Location

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