MEDICARE: GRANDMA FEE-FEE'S HOME CARE, LLC

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	251E00000X	Home Health Agency	207444	FL
2	253Z00000X	In Home Supportive Care Agency
3	261QD1600X	Developmental Disabilities Clinic/Center
4	347C00000X	Private Vehicle
5	385H00000X	Respite Care
6	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457838583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDMA FEE-FEE'S HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1710 E TIFFANY DR
Second Line	:
City	:	MANGONIA PARK
State	:	FL
Zip	:	33407-3242
Country	:	US
Telephone Number	:	772-307-9516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 E TIFFANY DR
Second Line	:
City	:	MANGONIA PARK
State	:	FL
Zip	:	33407-3242
Country	:	US
Telephone Number	:	772-307-9516
Fax Number	:

Authorized Official
Title or Position	:	CEO/ADMINISTRATIONN
Name	:	CAMBREA NISBETT
Credential	:
Telephone Number	:	772-307-9516

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	02/27/2025

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Directions to “GRANDMA FEE-FEE'S HOME CARE, LLC ” Practice Location

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