MEDICARE: GRANDPARENTS HOUSE ALF 2 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1841135852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDPARENTS HOUSE ALF 2 INC

Provider Business Mailing Address
First Line	:	1517 SW BELLEVUE AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-1102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 SW BELLEVUE AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-1102
Country	:	US
Telephone Number	:	772-985-8841
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REGLA RODRIGUEZ
Credential	:
Telephone Number	:	772-985-8841

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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