Grace Manor Suites

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

11995 Issued in FL

Legal business name

GRACE MANOR SUITES

Practice address

4620 N Socrum Loop Road
Lakeland, FL 33809

Phone

(863) 577-0977

Fax

(863) 577-0984

NPI assigned

Apr 16, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Savitri Johnson

Title

Administrative Assistant

Phone

(863) 226-0358

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1750700860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2480",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338062480",
            "telephone_number": "863-937-9114",
            "fax_number": "863-510-5952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 N SOCRUM LOOP ROAD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33809",
            "telephone_number": "863-577-0977",
            "fax_number": "863-577-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MANOR SUITES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-16",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SAVITRI",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "863-226-0358",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "11995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112829400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Goutzos
• Ankur Kumar Goyal, M.D., MSC
• Saachi Goyal, DDS
• Grace & Faith Care Agency LLC
• Grace Manor at Lake Morton, LLC
• David W Graham Jr., MD
• Maittee Grana
• Preetham Grandhi, M.D.
• Aitor Granero Lozano
• Grannys in Home Care, Inc.

• Assisted Living Facility in Lakeland, FL
• Providers in Lakeland, 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 Apr 24, 2023; 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.