MEDICARE: SYLVANGLADE HOME, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	MHL041572	NC

General Provider Information

NPI Number	:	1497844302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLVANGLADE HOME, INC.

Provider Business Mailing Address
First Line	:	4915 SYLVANGLADE ROAD
Second Line	:
City	:	MCLEANSVILLE
State	:	NC
Zip	:	27301
Country	:	US
Telephone Number	:	336-772-0952
Fax Number	:	336-356-2156

Provider Business Practice Location Address
First Line	:	4915 SYLVANGLADE RD
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9753
Country	:	US
Telephone Number	:	336-772-0952
Fax Number	:	336-356-2156

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. HATTIE GRAVES
Credential	:
Telephone Number	:	336-772-0952

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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