Grace Manor Alf LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

13186 Issued in FL

Legal business name

GRACE MANOR ALF LLC

Practice address

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

Phone

(727) 666-5060

NPI assigned

Jun 19, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maryann Pantonial

Title

Owner

Phone

(727) 666-5060

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1306330774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5916 45TH AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337095105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5916 45TH AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337095105",
            "telephone_number": "727-666-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MANOR ALF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "PANTONIAL",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-666-5060"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "13186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Saint Petersburg, FL
• Providers in Saint Petersburg, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.