MEDICARE: GRANGEFORD HOLDINGS 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	251E00000X	Home Health Agency	HHA#299992935	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	693524996	OTHER	FL	APD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	693524998	OTHER	FL	H & C BASED

General Provider Information

NPI Number	:	1467687111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANGEFORD HOLDINGS INC

Provider Business Mailing Address
First Line	:	1850 BOY SCOUT DR
Second Line	:	SUITE A103
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2127
Country	:	US
Telephone Number	:	239-337-4263
Fax Number	:	239-247-5151

Provider Business Practice Location Address
First Line	:	1850 BOY SCOUT DR
Second Line	:	SUITE A103
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2127
Country	:	US
Telephone Number	:	239-337-4263
Fax Number	:	239-247-5151

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. ROBERT I. THOMAS
Credential	:
Telephone Number	:	239-337-4263

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	04/21/2014

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Directions to “GRANGEFORD HOLDINGS INC ” Practice Location

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