Healthcare Provider Details

I. General information

NPI: 1750305033
Provider Name (Legal Business Name): GRAYSON FACILITY OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S. INDEPENDENCE AVENUE
INDEPENDENCE VA
24348-3857
US

IV. Provider business mailing address

PO BOX 857
INDEPENDENCE VA
24348-0857
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-0303
  • Fax: 276-773-0404
Mailing address:
  • Phone: 276-773-0303
  • Fax: 276-773-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TIM LEHNER
Title or Position: MANAGER
Credential:
Phone: 770-698-9040