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General NPI Number Information
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NPI Number | 1437247129
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Entity Type | Organization
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Legal Business Name | GRACE STREET ASSOCIATES
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1503 GRACE ST
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City | LYNCHBURG
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State | VA
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Zip | 24504-3211
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Country | US
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Telephone | 434-528-0969
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Fax | 434-846-3549
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Provider Business Mailing Address
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Address Line | 1503 GRACE ST
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City | LYNCHBURG
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State | VA
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Zip | 24504-3211
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Country | US
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Telephone | 434-528-0969
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Fax | 434-846-3549
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CAROLYN E. WOOTEN
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Credential | LNHA
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Telephone | 434-528-0969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH2561
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | RO06002
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License Number State | VA
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