Provider Demographics
NPI:1093146938
Name:GRAND PALMS ALF OPERATOR LLC
Entity Type:Organization
Organization Name:GRAND PALMS ALF OPERATOR LLC
Other - Org Name:GRAND PALMS ASSISTED LIVING & MEMORY CARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-3376
Mailing Address - Street 1:600 N ECONLOCKHATCHEE TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6402
Mailing Address - Country:US
Mailing Address - Phone:407-529-1000
Mailing Address - Fax:
Practice Address - Street 1:600 N ECONLOCKHATCHEE TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6402
Practice Address - Country:US
Practice Address - Phone:407-529-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility