Organization · NPI-2

Grace Manor Alf LLC

Assisted Living Facility · Saint Petersburg, FL

NPI number1306330774
StatusActive
Last updated in NPPESJun 19, 2018

Details

NPI
1306330774
Entity type
Organization (NPI-2)
Legal business name
Grace Manor Alf LLC
Organization subpart
No
Enumeration date
Jun 19, 2018
Last updated
Jun 19, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility13186FLYes

Practice location

5916 45th Ave N
Saint Petersburg, FL 33709-5105

Phone 727-666-5060

Mailing address

5916 45th Ave N
Saint Petersburg, FL 33709-5105

Authorized official

Maryann Pantonial
Owner
7276665060

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