Healthcare Provider Details

I. General information

NPI: 1831752542
Provider Name (Legal Business Name): GRANT CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 MAJESTIC PALM CIR APT 202
RIVERVIEW FL
33578-9435
US

IV. Provider business mailing address

10120 MAJESTIC PALM CIR APT 202
RIVERVIEW FL
33578-9435
US

V. Phone/Fax

Practice location:
  • Phone: 813-466-8793
  • Fax:
Mailing address:
  • Phone: 813-466-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNICE SIMMONS
Title or Position: OWNER
Credential: RN
Phone: 813-466-8793