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General NPI Number Information
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NPI Number | 1679012066
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Entity Type | Organization
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Legal Business Name | GRAND PALM SERVICES LLC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 950 S PINE ISLAND RD STE 150A
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City | PLANTATION
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State | FL
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Zip | 33324-3918
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Country | US
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Telephone | 954-727-8167
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Fax | 954-727-8168
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Provider Business Mailing Address
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Address Line | 950 S PINE ISLAND RD STE 150A
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City | PLANTATION
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State | FL
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Zip | 33324-3918
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Country | US
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Telephone | 954-727-8167
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Fax | 954-727-8168
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RONALD SERRANO YUSON
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Credential |
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Telephone | 954-727-8167
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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 | 30211861
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License Number State | FL
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