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Organization
GRAND CANYON GROUP HOME LLC
Active
Organization
GRAND CANYON GROUP HOME LLC
Active
Parent organization
GRAND CANYON GROUP HOME LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRAND CANYON GROUP HOME LLC
Authorized official
CASSANDRA VIRGINIA SIMPSON RN (EXECUTIVE DIRECTOR)
(813) 810-6844
Entity
Organization
Contact information
Practice address
5208 CHERRY AVE, SEFFNER, FL 33584-4406
(813) 810-6844
(813) 862-1072
Mailing address
PO BOX 963, VALRICO, FL 33595-0963
(813) 810-6844
(813) 862-1072
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
NULL
251E00000X
Home Health Agency
—
NULL
251J00000X
Nursing Care Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
313M00000X
Nursing Facility/Intermediate Care Facility
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
NULL
320700000X
Physical Disabilities Residential Treatment Facility
—
NULL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
09/25/2025
Last updated
09/25/2025
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