Organization
GRACE VILLA FACILITY LLC
Active
Other names
Grace Manor
Organization subpart
No
Provider details
NPI number
Authorized official
HAFEEZ RAHAMAN ALI (ADMINISTRATOR)
(407) 895-8418
Entity
Organization
Contact information
Practice address
321 E HARVARD STREET, ORLANDO, FL 32804
(407) 895-8418
(407) 895-8229
Mailing address
321 E HARVARD ST, ORLANDO, FL 32804-5526
(407) 895-8418
(407) 895-8229
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL8445
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
675965300
—
FL
Enumeration date
08/15/2012
Last updated
08/15/2012
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