Grand Victorian of Rockford, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

GRAND VICTORIAN OF ROCKFORD, LLC

Practice address

3495 McFarland Rd
Rockford, IL 61114-5609

Phone

(815) 654-1400

Fax

(815) 654-1488

NPI assigned

Jun 21, 2007

Organization subpart

No

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

Authorized official

Name

Mr. John Holtz

Title

Controller

Phone

(541) 747-3373

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1891991550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 CENTENNIAL LOOP",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974017900",
            "telephone_number": "541-747-3373",
            "fax_number": "541-747-0673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3495 MCFARLAND RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145609",
            "telephone_number": "815-654-1400",
            "fax_number": "815-654-1488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND VICTORIAN OF ROCKFORD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "HOLTZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "541-747-3373",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruby Lanelle Gowdy
• Vijay K Goyal, M.D.
• Jacek W Graczykowski, MD
• Grand Smiles 4, PLLC
• Grand Victorian of Rockford
• Aleah Aaron Grant, NP
• Ronald S Grant, MD
• Courtney Leanne Gray, ATC
• Dale R Gray, M.D.
• Sarah Elizabeth Gray

• Point of Service in Rockford, IL
• Providers in Rockford, IL by specialty
• Point of Service in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.