Organization · Type 2 NPI
Grand Canyon Group Home LLC
Emotionally Disturbed Childrens' Residential Treatment Facility · Seffner, FL
Practice location
5208 Cherry Ave
Seffner, FL 33584-4406
Fax (813) 862-1072
Mailing address
PO Box 963
Valrico, FL 33595-0963
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Case Management Agency | 251B00000X | None listed |
| Home Health Agency | 251E00000X | None listed |
| Nursing Care Agency | 251J00000X | None listed |
| Community/Behavioral Health Agency | 251S00000X | None listed |
| Nursing Facility/Intermediate Care Facility | 313M00000X | None listed |
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | None listed |
| Physical Disabilities Residential Treatment Facility | 320700000X | None listed |
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | None listed |
| Emotionally Disturbed Childrens' Residential Treatment Facility Primary | 322D00000X | None listed |
Emotionally Disturbed Childrens' Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
About NPI 1750254850
Grand Canyon Group Home LLC's National Provider Identifier is 1750254850, issued on Sep 25, 2025. The primary taxonomy on file is Emotionally Disturbed Childrens' Residential Treatment Facility (322D00000X), and the practice location is in Seffner, FL. The record was last updated on Sep 25, 2025.