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General NPI Number Information
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NPI Number | 1174673933
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Entity Type | Organization
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Legal Business Name | GRANDVIEW VILLA ASSISTED LIVING LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2544 GRANDVIEW CIR SW
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City | LENOIR
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State | NC
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Zip | 28645-9638
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Country | US
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Telephone | 828-757-0136
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Fax | 828-757-0213
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Provider Business Mailing Address
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Address Line | 2544 GRANDVIEW CIR SW
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City | LENOIR
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State | NC
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Zip | 28645-9638
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Country | US
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Telephone | 828-757-0136
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Fax | 828-757-0213
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Authorized Official
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Title or Position | MEMBER-MANAGER
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Name | MRS. LILLIE JEANETTE HARTLEY
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Credential |
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Telephone | 828-757-0136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HAL-014-015
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License Number State | NC
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