Provider Demographics
NPI:1295793008
Name:GRAND OPPORTUNITY HOME HEALTH,INC.
Entity type:Organization
Organization Name:GRAND OPPORTUNITY HOME HEALTH,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AILIUJ
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-221-9090
Mailing Address - Street 1:13911 SW 42ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6403
Mailing Address - Country:US
Mailing Address - Phone:305-221-9090
Mailing Address - Fax:305-221-9099
Practice Address - Street 1:13911 SW 42ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6403
Practice Address - Country:US
Practice Address - Phone:305-221-9090
Practice Address - Fax:305-221-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1295793008OtherMEDICARE FEE FOR SERVICE
FL1295793008Medicaid
FL1295793008OtherMEDICARE FEE FOR SERVICE