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General NPI Number Information
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NPI Number | 1750945200
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Entity Type | Organization
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Legal Business Name | GRACA HOLDINGS LLC
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 891 NOELL LN
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-1742
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Country | US
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Telephone | 252-443-7144
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Fax |
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Provider Business Mailing Address
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Address Line | 143 ROSEDALE DR
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-9810
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Country | US
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Telephone | 252-562-6593
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANA R. SMITH
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Credential |
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Telephone | 252-562-6593
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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 |
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License Number State |
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