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General NPI Number Information
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NPI Number | 1467687111
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Entity Type | Organization
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Legal Business Name | GRANGEFORD HOLDINGS INC
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 1850 BOY SCOUT DR SUITE A103
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City | FORT MYERS
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State | FL
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Zip | 33907-2127
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Country | US
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Telephone | 239-337-4263
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Fax | 239-247-5151
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Provider Business Mailing Address
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Address Line | 1850 BOY SCOUT DR SUITE A103
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City | FORT MYERS
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State | FL
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Zip | 33907-2127
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Country | US
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Telephone | 239-337-4263
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Fax | 239-247-5151
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. ROBERT I. THOMAS
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Credential |
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Telephone | 239-337-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA#299992935
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License Number State | FL
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