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General NPI Number Information
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NPI Number | 1033191499
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Entity Type | Organization
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Legal Business Name | THE GRAND OAKS TOO
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 20TH ST E
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City | BRADENTON
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State | FL
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Zip | 34208-1528
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Country | US
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Telephone | 941-723-1116
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Fax | 484-805-9930
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Provider Business Mailing Address
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Address Line | 811 15TH AVE W
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City | PALMETTO
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State | FL
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Zip | 34221-4467
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Country | US
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Telephone | 941-723-1116
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Fax | 484-805-9930
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Authorized Official
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Title or Position | RN ADMINISTRATOR
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Name | TIFFANY FREENY
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Credential | RN
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Telephone | 941-723-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALF10745
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License Number State | FL
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