Provider Demographics
NPI:1457950479
Name:GRANNYS IN HOME CARE, INC.
Entity Type:Organization
Organization Name:GRANNYS IN HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:NECOLE
Authorized Official - Middle Name:JAVAN
Authorized Official - Last Name:DULING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:863-808-3533
Mailing Address - Street 1:PO BOX 91092
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-1092
Mailing Address - Country:US
Mailing Address - Phone:863-808-3533
Mailing Address - Fax:
Practice Address - Street 1:4415 FLORIDA NATIONAL DR STE 201
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1569
Practice Address - Country:US
Practice Address - Phone:863-808-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty