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General NPI Number Information
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NPI Number | 1770176356
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Entity Type | Organization
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Legal Business Name | MY GRANDPARENTS HOUSE
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 3284 LANDING VW
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City | TAVARES
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State | FL
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Zip | 32778-2035
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Country | US
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Telephone | 862-334-9703
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Fax |
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Provider Business Mailing Address
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Address Line | 220 STRAIGHT ST APT 311
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City | PATERSON
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State | NJ
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Zip | 07501-1953
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SOPHIA PRISCILLA PEART
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Credential |
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Telephone | 862-334-9703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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