Organization
GRAND RISING GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL JEAN LPN (OWNER)
(239) 634-6859
Entity
Organization
Contact information
Practice address
3401 21ST ST SW, LEHIGH ACRES, FL 33976-3513
(239) 634-6859
Mailing address
3401 21ST ST SW, LEHIGH ACRES, FL 33976-3513
(239) 634-6859
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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