MEDICARE: GRAMPSN'GRANNIES

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	310400000X	Assisted Living Facility		GA

General Provider Information

NPI Number	:	1568665867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAMPSN'GRANNIES

Provider Business Mailing Address
First Line	:	502 N HOUSTON RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 N HOUSTON RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3051
Country	:	US
Telephone Number	:	478-329-8611
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KELLI SIMONS
Credential	:
Telephone Number	:	478-329-8611

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/22/2020

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Directions to “GRAMPSN'GRANNIES ” Practice Location

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