MEDICARE: GRANDMA'S HOUSE CO. LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251X00000X	Supports Brokerage Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1831992999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDMA'S HOUSE CO. LLC

Provider Business Mailing Address
First Line	:	4016 NEVADA AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55427-1340
Country	:	US
Telephone Number	:	218-531-3846
Fax Number	:

Provider Business Practice Location Address
First Line	:	4016 NEVADA AVE N
Second Line	:
City	:	NEW HOPE
State	:	MN
Zip	:	55427-1340
Country	:	US
Telephone Number	:	218-531-3846
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	JESSICA GILBEUNA
Credential	:	RN
Telephone Number	:	218-671-0959

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	04/01/2025

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Directions to “GRANDMA'S HOUSE CO. LLC ” Practice Location

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