Provider Demographics
NPI:1366919565
Name:GRAND VILLA OF LARGO
Entity type:Organization
Organization Name:GRAND VILLA OF LARGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-888-0168
Mailing Address - Street 1:535 N NOVA RD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4405
Mailing Address - Country:US
Mailing Address - Phone:404-888-0168
Mailing Address - Fax:
Practice Address - Street 1:750 STARKEY RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2365
Practice Address - Country:US
Practice Address - Phone:727-215-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QSH/MID FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility