NPIMap

Organization Active NPI

Graceson Manor

  • Assisted Living Facility
  • Reidsville, NC
National Provider Identifier
1104936103
Registry record updated May 20, 2008
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Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
FCL-079-054 Issued in NC
Legal business name
GRACESON MANOR
Practice address
116 Gwynn Dr
Reidsville, NC 27320-8710
Phone
(336) 349-2806
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Brenda L Gwynn
Title
Owner/Administrator
Phone
(336) 349-3610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X FCL-079-054 NC Primary

Addresses

Primary practice location

116 Gwynn Dr
Reidsville, NC 27320-8710

Mailing address

116 Gwynn Dr
Reidsville, NC 27320-8710
Phone (336) 349-2806

Other identifiers 1

IdentifierTypeStateIssuer
7805575OtherNCEDS NUMBER

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1104936103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 GWYNN DR",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273208710",
            "telephone_number": "336-349-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 GWYNN DR",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273208710",
            "telephone_number": "336-349-2806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACESON MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "GWYNN",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "336-349-3610",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-079-054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS NUMBER",
            "identifier": "7805575",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reidsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.