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General NPI Number Information
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NPI Number | 1861716102
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Entity Type | Organization
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Legal Business Name | GRANDMOTHER'S HOME CARE CORP
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 4651 NW 23RD CT
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City | MIAMI
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State | FL
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Zip | 33142-4615
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Country | US
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Telephone | 305-633-3569
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Fax |
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Provider Business Mailing Address
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Address Line | 4651 NW 23RD CT
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City | MIAMI
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State | FL
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Zip | 33142-4615
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Country | US
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Telephone | 305-633-3569
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLEIDA QUINTANA
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Credential |
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Telephone | 786-370-3450
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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 | 11727
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License Number State | FL
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