Provider Demographics
NPI:1669130324
Name:GRANDE CYPRESS ALF LLC
Entity type:Organization
Organization Name:GRANDE CYPRESS ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RANEE
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-209-1440
Mailing Address - Street 1:426 SW COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1505
Mailing Address - Country:US
Mailing Address - Phone:386-209-1440
Mailing Address - Fax:
Practice Address - Street 1:970 SW PINEMOUNT RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-5845
Practice Address - Country:US
Practice Address - Phone:386-209-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SORENSEN & SMITH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility