Organization
GRACE MANOR SUITES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAVITRI JOHNSON (ADMINISTRATIVE ASSISTANT)
(863) 226-0358
Entity
Organization
Contact information
Practice address
4620 N SOCRUM LOOP ROAD, LAKELAND, FL 33809
(863) 577-0977
(863) 577-0984
Mailing address
PO BOX 2480, LAKELAND, FL 33806-2480
(863) 937-9114
(863) 510-5952
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11995
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112829400
—
FL
Enumeration date
04/16/2014
Last updated
04/24/2023
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