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General NPI Number Information
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NPI Number | 1043903065
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Entity Type | Organization
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Legal Business Name | GRANDE SENIOR LIVING LLC
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 725 DESOTO AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-2813
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Country | US
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Telephone | 352-544-0944
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Fax |
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Provider Business Mailing Address
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Address Line | 5801 ULMERTON RD STE 200
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City | CLEARWATER
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State | FL
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Zip | 33760-3951
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Country | US
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Telephone | 727-683-1200
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Fax |
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Authorized Official
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Title or Position | REGIONAL DIRECTOR OF OPERATIONS
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Name | KEVIN TAPP
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Credential |
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Telephone | 727-418-3148
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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 |
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License Number State |
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