NPIMap

Organization Active NPI

Grand Canyon Group Home LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Seffner, FL
National Provider Identifier
1750254850
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
GRAND CANYON GROUP HOME LLC
Practice address
5208 Cherry Ave
Seffner, FL 33584-4406
Phone
(813) 810-6844
Fax
(813) 862-1072
NPI assigned
Sep 25, 2025
Last updated
Sep 25, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
GRAND CANYON GROUP HOME LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Authorized official

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Home Health Agency 251E00000X
Nursing Care Agency 251J00000X
Nursing Facility/Intermediate Care Facility 313M00000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Physical Disabilities Residential Treatment Facility 320700000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

5208 Cherry Ave
Seffner, FL 33584-4406

Mailing address

PO Box 963
Valrico, FL 33595-0963
Phone (813) 810-6844

National Provider Directory

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

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1758758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1750254850",
    "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": "813-810-6844",
            "fax_number": "813-862-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5208 CHERRY AVE",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335844406",
            "telephone_number": "813-810-6844",
            "fax_number": "813-862-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CANYON GROUP HOME LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND CANYON GROUP HOME LLC",
        "enumeration_date": "2025-09-25",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "VIRGINIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "813-810-6844",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seffner, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; 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.