Provider Demographics
NPI:1922501394
Name:GRANTED ANGELS INC
Entity Type:Organization
Organization Name:GRANTED ANGELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-209-4238
Mailing Address - Street 1:6783 ROCKY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32442-4219
Mailing Address - Country:US
Mailing Address - Phone:850-209-4238
Mailing Address - Fax:850-592-2604
Practice Address - Street 1:2860 HIGHWAY 71 STE B
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1893
Practice Address - Country:US
Practice Address - Phone:850-209-4238
Practice Address - Fax:888-979-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023322000Medicaid