Grand Canyon Home Care Inc.

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

Legal business name

GRAND CANYON HOME CARE INC.

Practice address

420 E Southern Ave Ste 110a
Mesa, AZ 85204-4945

Phone

(480) 397-6010

NPI assigned

Jul 30, 2018

Organization subpart

Yes

Parent organization

GRAND CANYON HOME CAREAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yakov YushuvayevNPI 1225516578

Title

President

Phone

(907) 222-7666

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• grand canyon home care - MESA Doing business as

Tax ID family

Grand Canyon Home Care Inc2 organizations share this tax ID, including this one

Part of

Grand Canyon Home Care Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Grand Canyon Home Care Inc.

  • Attendant Care Provider
  • Phoenix, AZ
  • NPI 1972805679
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Grand Canyon Home Care Inc.

  • Attendant Care Provider
  • Phoenix, AZ
  • NPI 1972805679
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yakov Yushuvayev

  • Attendant Care Provider
  • Mesa, AZ
  • NPI 1225516578
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532908800000",
    "number": "1295213544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13201 N 35TH AVE STE 4B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850291231",
            "telephone_number": "602-795-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E SOUTHERN AVE STE 110A",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852044945",
            "telephone_number": "480-397-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CANYON HOME CARE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND CANYON HOME CARE",
        "enumeration_date": "2018-07-30",
        "last_updated": "2018-07-30",
        "status": "A",
        "authorized_official_last_name": "YUSHUVAYEV",
        "authorized_official_first_name": "YAKOV",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-222-7666"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "568006",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "grand canyon home care - MESA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaclyn Ann Grajewski
• Cindy Gramm
• Stephen Roger Grams, MA
• Molley Kay Granberry, PHARMD
• Corina Kay Grancorvitz, PHARMD
• Grand Canyon Perfusion, Inc.
• Carlos L Grandela, OD
• Caron C Grant-Ellis, RN
• Jesse Graves, RBT
• John A. Graves, DPT

• Attendant Care Provider in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Attendant Care Provider in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.