NPIMap

Organization Active NPI

Granite Falls LTC, LLC

Doing business as Kannon Creek Assisted Living

  • Adult Care Home Facility
  • Kannapolis, NC
National Provider Identifier
1174567531
Registry record updated Apr 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
HAL080003 Issued in NC
Legal business name
GRANITE FALLS LTC, LLC
Doing business as
Kannon Creek Assisted Living
Practice address
1808 N Cannon Blvd
Kannapolis, NC 28083-2670
Phone
(704) 932-5517
Fax
(704) 932-1200
NPI assigned
Jun 16, 2006
Last updated
Apr 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2017

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

Authorized official

Name
Ms. Karen G McDaniel
Title
President
Phone
(252) 523-9094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X HAL080003 NC Primary

Addresses

Primary practice location

1808 N Cannon Blvd
Kannapolis, NC 28083-2670

Mailing address

1808 N Cannon Blvd
Kannapolis, NC 28083-2670
Phone (704) 932-5517

Other identifiers 1

IdentifierTypeStateIssuer
7806637MedicaidNC

Other names 1

  • Kannon Creek Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491523200000",
    "number": "1174567531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 N CANNON BLVD",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280832670",
            "telephone_number": "704-932-5517",
            "fax_number": "704-932-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 N CANNON BLVD",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280832670",
            "telephone_number": "704-932-5517",
            "fax_number": "704-932-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE FALLS LTC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2017-04-07",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-523-9094",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL080003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806637",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kannon Creek Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kannapolis, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2017; 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.