Greatlife Home Care, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

GREATLIFE HOME CARE, LLC

Practice address

7880 Harbach Blvd
Clive, IA 50325-1240

Phone

(515) 918-3551

NPI assigned

Nov 30, 2022

Organization subpart

No

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

Authorized official

Name

Massara Goyom Komjo

Title

Owner

Phone

(515) 918-3551

Specialties & licenses 6

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1760192702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10069 LINCOLN AVE",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503256745",
            "telephone_number": "515-918-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7880 HARBACH BLVD",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503251240",
            "telephone_number": "515-918-3551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATLIFE HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-30",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "KOMJO",
        "authorized_official_first_name": "MASSARA",
        "authorized_official_middle_name": "GOYOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-918-3551"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Greatlifehomecare@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7880 Harbach Blvd",
            "city": "Clive",
            "state": "IA",
            "country_code": "US",
            "postal_code": "503251240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jason Michael Graham, ATC, LAT
• Lindsey Lea Grandbois, D.O.
• Yim Lae Graner
• Stephen Bernard Grant, MD
• William Thomas Grask, D.D.S.
• Katherine Greening, DPT
• Brenda Ann Greenwell, DPT
• Marshall Greiman, MD
• Kara Lynn Grett
• Dawn Grittmann, PHARMD

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Clive, IA
• Providers in Clive, IA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.