Provider Demographics
NPI:1902477243
Name:GRANDI CANCELLI 2, LLC
Entity Type:Organization
Organization Name:GRANDI CANCELLI 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KURKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CCM
Authorized Official - Phone:734-855-7187
Mailing Address - Street 1:17199 N LAUREL PARK DR STE 401
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7905
Mailing Address - Country:US
Mailing Address - Phone:734-855-7187
Mailing Address - Fax:734-293-0086
Practice Address - Street 1:17199 N LAUREL PARK DR STE 401
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7905
Practice Address - Country:US
Practice Address - Phone:734-855-7187
Practice Address - Fax:734-293-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty