MEDICARE: GRANDFRIENDZ, INC.

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	253Z00000X	In Home Supportive Care Agency	22793601	PA

General Provider Information

NPI Number	:	1215286307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDFRIENDZ, INC.

Provider Business Mailing Address
First Line	:	7259 MANSFIELD AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19138
Country	:	US
Telephone Number	:	267-312-3837
Fax Number	:

Provider Business Practice Location Address
First Line	:	7259 MANSFIELD AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19138
Country	:	US
Telephone Number	:	267-312-3837
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/FOUNDER
Name	:	MISS KEINA K EUBANKS
Credential	:	BS
Telephone Number	:	267-312-3837

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	09/05/2012

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