Provider Demographics
NPI:1679012066
Name:GRAND PALM SERVICES LLC
Entity Type:Organization
Organization Name:GRAND PALM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SERRANO
Authorized Official - Last Name:YUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-727-8167
Mailing Address - Street 1:950 S PINE ISLAND RD STE 150A
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3918
Mailing Address - Country:US
Mailing Address - Phone:954-727-8167
Mailing Address - Fax:954-727-8168
Practice Address - Street 1:950 S PINE ISLAND RD STE 150A
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3918
Practice Address - Country:US
Practice Address - Phone:954-727-8167
Practice Address - Fax:954-727-8168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211861251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health