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General NPI Number Information
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NPI Number | 1669130324
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Entity Type | Organization
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Legal Business Name | GRANDE CYPRESS ALF LLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 970 SW PINEMOUNT RD
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City | LAKE CITY
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State | FL
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Zip | 32024-5845
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Country | US
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Telephone | 386-209-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 426 SW COMMERCE DR
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City | LAKE CITY
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State | FL
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Zip | 32025-1505
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Country | US
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Telephone | 386-209-1440
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHELLE RANEE NORRIS
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Credential |
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Telephone | 386-209-1440
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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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