Grandtag Madisonrealty LLC

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

GRANDTAG MADISONREALTY LLC

Practice address

501 S College Ave
Claremont, CA 91711-5527

Phone

(909) 686-0117

NPI assigned

May 4, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Forbes Willard Burdette

Title

Managing Director

Phone

(626) 796-8700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1730678756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3452 E FOOTHILL BLVD STE 200",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911073158",
            "telephone_number": "626-796-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S COLLEGE AVE",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917115527",
            "telephone_number": "909-686-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDTAG MADISONREALTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-04",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "BURDETTE",
        "authorized_official_first_name": "FORBES",
        "authorized_official_middle_name": "WILLARD",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "626-796-8700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Esmeralda Gonzalez, OTR/L
• Nicole Lynn Goolsby, LMFT
• Vasudavan Govindasamy, M.S., CCC-SLP
• Ashley Ann Grammer
• Reighan Grandolfo
• Steven Michael Graves, ATC
• Green Life Legacy, LLC
• Green Medical Group
• Merceades Quinniece Green, MS, CCC-SLP
• Karen Greenbaum-Maya, PH. D.

• Contractor in Claremont, CA
• Providers in Claremont, CA by specialty
• Contractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.