Healthcare Provider Details

I. General information

NPI: 1952105207
Provider Name (Legal Business Name): GRAND VILLA OF ENGLEWOOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S RIVER RD
ENGLEWOOD FL
34223-3909
US

IV. Provider business mailing address

13770 58TH ST N STE 312
CLEARWATER FL
33760-3759
US

V. Phone/Fax

Practice location:
  • Phone: 941-474-8600
  • Fax:
Mailing address:
  • Phone: 727-726-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBIN MONTHIE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 727-726-3980