Healthcare Provider Details

I. General information

NPI: 1336302579
Provider Name (Legal Business Name): GRANVILLE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 COLLEGE ST
OXFORD NC
27565-2507
US

IV. Provider business mailing address

PO BOX 947
OXFORD NC
27565-0947
US

V. Phone/Fax

Practice location:
  • Phone: 919-690-3000
  • Fax: 919-603-1097
Mailing address:
  • Phone: 919-690-3000
  • Fax: 919-603-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: JAMIE PURVIS
Title or Position: CFO
Credential:
Phone: 919-690-3237