Provider Demographics
NPI:1174704266
Name:GRAND AMERICAN HOME CARE, INC.
Entity type:Organization
Organization Name:GRAND AMERICAN HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-292-3529
Mailing Address - Street 1:21649 GODDARD RD
Mailing Address - Street 2:SUITE B-125
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4299
Mailing Address - Country:US
Mailing Address - Phone:313-292-3529
Mailing Address - Fax:313-292-3787
Practice Address - Street 1:21649 GODDARD RD
Practice Address - Street 2:SUITE B-125
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4299
Practice Address - Country:US
Practice Address - Phone:313-292-3529
Practice Address - Fax:313-292-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health