Healthcare Provider Details

I. General information

NPI: 1174567531
Provider Name (Legal Business Name): GRANITE FALLS LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 N CANNON BLVD
KANNAPOLIS NC
28083-2670
US

IV. Provider business mailing address

1808 N CANNON BLVD
KANNAPOLIS NC
28083-2670
US

V. Phone/Fax

Practice location:
  • Phone: 704-932-5517
  • Fax: 704-932-1200
Mailing address:
  • Phone: 704-932-5517
  • Fax: 704-932-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL080003
License Number StateNC

VIII. Authorized Official

Name: MS. KAREN G MCDANIEL
Title or Position: PRESIDENT
Credential:
Phone: 252-523-9094