Organization
GREAT GRANDMA'S TENDER, LOVE AND CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PACK (OWNER)
(352) 583-3876
Entity
Organization
Contact information
Practice address
34729 ORCHID PKWY, RIDGE MANOR, FL 33523-8864
(352) 583-3876
(352) 583-3876
Mailing address
34729 ORCHID PKWY, RIDGE MANOR, FL 33523-8864
(352) 583-3876
(352) 583-3876
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
693102296
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231539
ACHA
FL
05
—
693102201
—
FL
05
—
693102296
—
FL
05
—
693102298
—
FL
Enumeration date
12/16/2010
Last updated
12/16/2010
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