MEDICARE: GRANNYS IN HOME CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1083570964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANNYS IN HOME CARE, INC.

Provider Business Mailing Address
First Line	:	4415 FLORIDA NATIONAL DR STE 201
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1569
Country	:	US
Telephone Number	:	863-808-3533
Fax Number	:	863-644-9194

Provider Business Practice Location Address
First Line	:	4415 FLORIDA NATIONAL DR STE 201
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1569
Country	:	US
Telephone Number	:	863-808-3533
Fax Number	:	863-644-9194

Authorized Official
Title or Position	:	OWNER
Name	:	MS. NECOLE JAVAN DULING
Credential	:	RN
Telephone Number	:	863-808-3533

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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1457950479 — GRANNYS IN HOME CARE, INC.
Practice Location Address:

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