Organization
GRAND LAKE HEALTH CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH JAMES GELINAS NP (OWNER/PROVIDER)
(918) 787-3491
Entity
Organization
Contact information
Practice address
601 S BROADWAY ST, GROVE, OK 74344-3429
(918) 801-6085
Mailing address
62500 E 247 LOOP, GROVE, OK 74344-7435
(918) 787-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
80573
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20313460A
—
OK
Enumeration date
09/05/2018
Last updated
02/25/2019
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