Healthcare Provider Details

I. General information

NPI: 1437247129
Provider Name (Legal Business Name): GRACE STREET ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 GRACE ST
LYNCHBURG VA
24504-3211
US

IV. Provider business mailing address

1503 GRACE ST
LYNCHBURG VA
24504-3211
US

V. Phone/Fax

Practice location:
  • Phone: 434-528-0969
  • Fax: 434-846-3549
Mailing address:
  • Phone: 434-528-0969
  • Fax: 434-846-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRO06002
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH2561
License Number StateVA

VIII. Authorized Official

Name: CAROLYN E. WOOTEN
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 434-528-0969