MEDICARE: GRANTS WELLNESS & REHABILITATION 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1568298404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANTS WELLNESS & REHABILITATION LLC

Provider Business Mailing Address
First Line	:	840 LOBO CANYON RD
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2172
Country	:	US
Telephone Number	:	505-287-8868
Fax Number	:	505-285-5581

Provider Business Practice Location Address
First Line	:	840 LOBO CANYON RD
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2172
Country	:	US
Telephone Number	:	505-287-8868
Fax Number	:	505-285-5581

Authorized Official
Title or Position	:	CFO
Name	:	DAVID GARETZ
Credential	:
Telephone Number	:	323-987-5954

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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