Provider Demographics
NPI:1457838583
Name:GRANDMA FEE-FEE'S HOME CARE, LLC
Entity Type:Organization
Organization Name:GRANDMA FEE-FEE'S HOME CARE, LLC
Other - Org Name:GRANDMA FEE-FEE'S HOME CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATIONN
Authorized Official - Prefix:
Authorized Official - First Name:CAMBREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-307-9516
Mailing Address - Street 1:108 N DEPOT DR # 305
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4420
Mailing Address - Country:US
Mailing Address - Phone:772-307-9516
Mailing Address - Fax:
Practice Address - Street 1:108 N DEPOT DR # 305
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4420
Practice Address - Country:US
Practice Address - Phone:772-307-9516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-21
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207444251E00000X
251G00000X, 253Z00000X, 261QD1600X, 347C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101765800Medicaid