Provider Demographics
NPI:1174957088
Name:GRAPEVINE HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:GRAPEVINE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-483-6505
Mailing Address - Street 1:8459 WHITE OAK AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3872
Mailing Address - Country:US
Mailing Address - Phone:909-483-6505
Mailing Address - Fax:909-944-3250
Practice Address - Street 1:8459 WHITE OAK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3872
Practice Address - Country:US
Practice Address - Phone:909-483-6505
Practice Address - Fax:909-944-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000797251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059182Medicare UPIN