Provider Demographics
NPI:1669773735
Name:GRACE FULL LIVING FOR SENIORS INC.
Entity type:Organization
Organization Name:GRACE FULL LIVING FOR SENIORS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PIER
Authorized Official - Middle Name:
Authorized Official - Last Name:GASMENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-595-7353
Mailing Address - Street 1:747 BON AIR ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4631
Mailing Address - Country:US
Mailing Address - Phone:863-688-1196
Mailing Address - Fax:863-687-7707
Practice Address - Street 1:601 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7320
Practice Address - Country:US
Practice Address - Phone:727-328-1414
Practice Address - Fax:727-328-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility