MEDICARE: GRANDMOTHER'S HOME CARE CORP

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	11727	FL

General Provider Information

NPI Number	:	1861716102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDMOTHER'S HOME CARE CORP

Provider Business Mailing Address
First Line	:	4651 NW 23RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-4615
Country	:	US
Telephone Number	:	305-633-3569
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 NW 23RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-4615
Country	:	US
Telephone Number	:	305-633-3569
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLEIDA QUINTANA
Credential	:
Telephone Number	:	786-370-3450

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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Directions to “GRANDMOTHER'S HOME CARE CORP ” Practice Location

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