Provider Demographics
NPI:1043088024
Name:GROVE DEVELOPMENT OPERATIONS LLC
Entity type:Organization
Organization Name:GROVE DEVELOPMENT OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:FAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-0158
Mailing Address - Street 1:16404 NE 127TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8969
Mailing Address - Country:US
Mailing Address - Phone:208-371-0158
Mailing Address - Fax:
Practice Address - Street 1:17996 BUSINESS 13
Practice Address - Street 2:
Practice Address - City:REEDS SPRING
Practice Address - State:MO
Practice Address - Zip Code:65737-9663
Practice Address - Country:US
Practice Address - Phone:417-272-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility