Gracey Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

147010191 Issued in GA

Legal business name

GRACEY MANOR LLC

Practice address

3400 Youth Monroe Rd
Loganville, GA 30052-4327

Phone

(770) 466-1535

NPI assigned

Sep 16, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Shaundell Blege

Title

On Site Manager

Phone

(404) 889-7145

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1194033894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 YOUTH MONROE RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 YOUTH MONROE RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524327",
            "telephone_number": "770-466-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEY MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "BLEGE",
        "authorized_official_first_name": "SHAUNDELL",
        "authorized_official_title_or_position": "ON SITE MANAGER",
        "authorized_official_telephone_number": "404-889-7145",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "147010191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joav Gomez, PT, DPT
• Theresa G. Goodman, NP-C
• Kareen Marie Gordon
• Chandan Gosar, OTR
• Simone Goss
• Wendy K Grage, CSFA
• Emily Paulette Graham, LCSW
• Latisha Graham
• Vilma Granger
• Bianca Tiehena-Elizabeth Grant

• Assisted Living Facility in Loganville, GA
• Providers in Loganville, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.