Provider Demographics
NPI:1356055180
Name:GRAND POTENTIAL LLC
Entity type:Organization
Organization Name:GRAND POTENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPURLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:303-590-8611
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-0677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 LYONS HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:GRAND LAKE
Practice Address - State:CO
Practice Address - Zip Code:80447-8044
Practice Address - Country:US
Practice Address - Phone:303-590-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health