MEDICARE: GRANDVIEW CARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215591722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDVIEW CARE LLC

Provider Business Mailing Address
First Line	:	8465 W GRAND AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-8102
Country	:	US
Telephone Number	:	602-812-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	4023 W GRANDVIEW RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2732
Country	:	US
Telephone Number	:	602-368-4468
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DENNIS VALENTINE
Credential	:	ASSISTED LIVING MNGR
Telephone Number	:	602-368-4468

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	06/11/2019

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