Healthcare Provider Details

I. General information

NPI: 1023034360
Provider Name (Legal Business Name): GRNC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 SANDERS AVE
GRACEVILLE FL
32440-1854
US

IV. Provider business mailing address

2979 PGA BLVD
PALM BEACH GARDENS FL
33410-2911
US

V. Phone/Fax

Practice location:
  • Phone: 850-263-4447
  • Fax: 850-263-4201
Mailing address:
  • Phone: 561-627-0664
  • Fax: 561-627-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1253096
License Number StateFL

VIII. Authorized Official

Name: MRS. JULIE C. KLEISER
Title or Position: AUDIT & REIMBURSEMENT SR. ANALYST
Credential:
Phone: 561-627-0664