Provider Demographics
NPI:1356851224
Name:GRANNIE'S HOME ALF INC
Entity Type:Organization
Organization Name:GRANNIE'S HOME ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIROLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-363-2530
Mailing Address - Street 1:5554 PENTAIL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-1936
Mailing Address - Country:US
Mailing Address - Phone:813-363-2530
Mailing Address - Fax:
Practice Address - Street 1:5554 PENTAIL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-1936
Practice Address - Country:US
Practice Address - Phone:813-363-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13073310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility