Provider Demographics
NPI:1366218653
Name:GRAND VALLEY IN-HOME 24 HR NURSING LLC
Entity type:Organization
Organization Name:GRAND VALLEY IN-HOME 24 HR NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SUPERVISORY NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:CHEREE
Authorized Official - Last Name:KORNDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-463-0331
Mailing Address - Street 1:804 CHERYL SUE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:US
Mailing Address - Phone:307-463-0331
Mailing Address - Fax:
Practice Address - Street 1:804 CHERYL SUE DRIVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501
Practice Address - Country:US
Practice Address - Phone:307-463-0331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health