Organization Name: | GRANNY'S DOWNHOME CARE CENTER |
NPI Number: | 1215374749 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATSY JEAN BERRY (OWNER) |
Mailing Address: | 2200 E Wolverine Cir Wasilla |
State: | AK US |
Postal Code: | 996542708 |
Phone Number: | 9073575803 |
Fax Number: | 9073575813 |
NPI Enumeration Date: | 05/23/2013 |
NPI Last Update Date: | 05/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | 100513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |