NPIMap

Organization Active NPI

Grand Canyon Group Home LLC

  • In Home Supportive Care Agency
  • Valrico, FL
National Provider Identifier
1477278232
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
GRAND CANYON GROUP HOME LLC
Practice address
949 Grand Canyon Dr
Valrico, FL 33594-4351
Phone
(813) 530-0004
Fax
(813) 862-1072
NPI assigned
Oct 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Cassandra Virginia Simpson, BSN, RNNPI 1043722838
Title
Director
Phone
(813) 810-6844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Nursing Care Agency 251J00000X
In Home Supportive Care Agency 253Z00000X Primary
Developmental Disabilities Clinic/Center 261QD1600X
Health Service Clinic/Center 261QH0100X
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X

Addresses

Primary practice location

949 Grand Canyon Dr
Valrico, FL 33594-4351

Mailing address

PO Box 963
Valrico, FL 33595-0963
Phone (813) 530-0004

National Provider Directory

National Provider Directory
Tax ID family
Grand Canyon Group Home LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1477278232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 963",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335950963",
            "telephone_number": "813-530-0004",
            "fax_number": "813-862-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 GRAND CANYON DR",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335944351",
            "telephone_number": "813-530-0004",
            "fax_number": "813-862-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CANYON GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "VIRGINIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "813-810-6844",
        "authorized_official_credential": "BSN, RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valrico, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; 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.