Healthcare Provider Details

I. General information

NPI: 1710895958
Provider Name (Legal Business Name): GOLDEN GRACE HOMECARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10812 DRAGONWOOD DR
TAMPA FL
33647-4039
US

IV. Provider business mailing address

10812 DRAGONWOOD DR
TAMPA FL
33647-4039
US

V. Phone/Fax

Practice location:
  • Phone: 813-894-3102
  • Fax:
Mailing address:
  • Phone: 813-894-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA KALISH
Title or Position: OWNER/ADMINISTRATOR
Credential: RN,BSN
Phone: 813-894-3102