Healthcare Provider Details

I. General information

NPI: 1235890625
Provider Name (Legal Business Name): GRACEVIEW HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W J ST
NEWTON NC
28658-3540
US

IV. Provider business mailing address

PO BOX 58
SHERRILLS FORD NC
28673-0058
US

V. Phone/Fax

Practice location:
  • Phone: 704-325-3026
  • Fax: 704-325-3378
Mailing address:
  • Phone: 919-259-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC ADDO
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-259-9068