Organization
GRAND CANYON GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA VIRGINIA SIMPSON BSN, RN (DIRECTOR)
(813) 810-6844
Entity
Organization
Contact information
Practice address
949 GRAND CANYON DR, VALRICO, FL 33594-4351
(813) 530-0004
(813) 862-1072
Mailing address
PO BOX 963, VALRICO, FL 33595-0963
(813) 530-0004
(813) 862-1072
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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