Healthcare Provider Details

I. General information

NPI: 1104249960
Provider Name (Legal Business Name): GARNERS HOUSE OF GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 DIXIE ST
BURLINGTON NC
27217-6620
US

IV. Provider business mailing address

PO BOX 844
BURLINGTON NC
27216-0844
US

V. Phone/Fax

Practice location:
  • Phone: 336-350-8478
  • Fax:
Mailing address:
  • Phone: 336-350-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL001233
License Number StateNC

VIII. Authorized Official

Name: SHEMIA L GARNER
Title or Position: OWNER
Credential:
Phone: 336-263-7146