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General NPI Number Information
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NPI Number | 1104249960
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Entity Type | Organization
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Legal Business Name | GARNERS HOUSE OF GRACE
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 914 DIXIE ST
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City | BURLINGTON
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State | NC
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Zip | 27217-6620
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Country | US
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Telephone | 336-350-8478
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844
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City | BURLINGTON
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State | NC
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Zip | 27216-0844
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Country | US
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Telephone | 336-350-8478
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHEMIA L GARNER
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Credential |
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Telephone | 336-263-7146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL001233
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License Number State | NC
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