Grand B1

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

GRAND B1

Practice address

6523 N Sheridan Rd
Edmore, MI 48829-9726

Phone

(231) 354-6564

Fax

(231) 354-6521

NPI assigned

Jun 19, 2021

Last updated

Jun 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Linda V Powell, AFC

Title

Administrator

Phone

(231) 354-6564

Specialties & licenses 1

Addresses

Other names 2

• Grateful Hearts Other name
• Sisco's Leisure Living Other name

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

{
    "created_epoch": "1624060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1306415849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 CORAL RD",
            "city": "CORAL",
            "state": "MI",
            "postal_code": "493229649",
            "telephone_number": "231-354-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6523 N SHERIDAN RD",
            "city": "EDMORE",
            "state": "MI",
            "postal_code": "488299726",
            "telephone_number": "231-354-6564",
            "fax_number": "231-354-6521"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11400 Coral Rd",
            "address_purpose": "LOCATION",
            "city": "Coral",
            "state": "MI",
            "postal_code": "493229649",
            "country_code": "US",
            "telephone_number": "231-354-6564",
            "fax_number": "231-354-6521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRAND B1",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-19",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-354-6564",
        "authorized_official_credential": "AFC"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grateful Hearts",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Grateful Hearts",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Sisco's Leisure Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Adult Care Home Facility in Edmore, MI
• Providers in Edmore, MI by specialty
• Adult Care Home Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.