NPIMap

Organization Active NPI

Granite Falls LTC, LLC

Doing business as Jacob's Creek Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Madison, NC
National Provider Identifier
1255367447
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0092 Issued in NC
Legal business name
GRANITE FALLS LTC, LLC
Doing business as
Jacob's Creek Nursing and Rehabilitation Center
Practice address
1721 Bald Hill Loop
Madison, NC 27025-7624
Phone
(336) 548-9658
Fax
(336) 548-1299
NPI assigned
Jun 23, 2006
Last updated
Jul 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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
Skilled Nursing Facility 314000000X NH0092 NC Primary

Addresses

Primary practice location

1721 Bald Hill Loop
Madison, NC 27025-7624

Mailing address

1721 Bald Hill Loop
Madison, NC 27025-7624
Phone (336) 548-9658

Other names 1

  • Jacob's Creek Nursing and Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110413000355 NC Part A Provider - Skilled Nursing Facility 5799966727 Practice locations: Madison, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255367447. Details of each certification follow.

Skilled nursing facility certification: CCN 345050

Legal name
GRANITE FALLS LTC, LLC
Doing business as
JACOBS CREEK NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 8, 1968
Last certification
Sep 18, 2024
Beds
170
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Aug 20, 2010 in NC
Enrollment address
1721 Bald Hill Loop
Madison, NC 27025-7624
Nursing home name
JACOB'S CREEK NURSING AND REHABILITATION CENTER
Affiliated entity
PRINCIPLE LONG TERM CARE

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Jacob's Creek Nursing and Rehabilitation CenterCCN 345050 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 8, 1968
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
170152.2 residents per day on average
Chain
Principle Long Term Care40 facilities in the chain
Penalties (3 years)
3Fines totaling $16,801

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0931113Granite Falls LTC, LLC1721 Bald Hill Loop, Madison, NC 27025Certificate of waiverJul 22, 2027

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.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Raymond Gregg Hill Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2011 18%
Robert O'Neil Hill Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2011 20%
Stephen Britt Hill Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2011 20%
Gale R Boice Individual Corporate OfficerCfo Mar 5, 2018
Dianne Johnson Individual Corporate OfficerTreasurer Jan 1, 2011
Principle Long Term Care, Inc. Organization, Kinston, NC Corporation, Management services company, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2011 50%
Operational/Managerial Control Jan 1, 2011 50%
Adp of the SNF Apr 14, 2025
Kathleen S Wilson Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF May 12, 2025
Principle It Services, Inc. Organization, Kinston, NC Corporation, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2011 50%
James Walter Goforth Individual Managing Control - Governing Body Jan 1, 2025
Adp of the SNF May 12, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 43

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Birch LTC Group, LLC

    dba Barbour Court Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Smithfield, NC
    • NPI 1225064777

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Birch LTC Group, LLC

    dba Willow Creek Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Goldsboro, NC
    • NPI 1508802497

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Continuum II Home Care & Hospice, Inc.

    dba Continuum II Home Care & Hospice of Pender County

    • Community Based Hospice Care Agency
    • Hampstead, NC
    • NPI 1457648909

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Continuum II Home Care & Hospice, Inc.

    dba Continuum Home Care & Hospice of Lenoir

    • Community Based Hospice Care Agency
    • Kinston, NC
    • NPI 1619074937

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Eagle Peak LTC Group, LLC

    dba Westwood Hills Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Wilkesboro, NC
    • NPI 1184650541

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Eagle Peak LTC Group, LLC

    dba Franklin Oaks Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Louisburg, NC
    • NPI 1376570275

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Eagle Peak LTC Group, LLC

    dba Kerr Lake Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Henderson, NC
    • NPI 1972547321

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Everest Long Term Care, LLC

    dba Springbrook Nursing and Rehabilitation

    • Skilled Nursing Facility
    • Clayton, NC
    • NPI 1003205337

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Everest Long Term Care, LLC

    dba Tower Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Raleigh, NC
    • NPI 1356387153

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Everest Long Term Care, LLC

    dba LAKE PARK Nursing & Rehabilitation Center

    • Skilled Nursing Facility
    • Indian Trail, NC
    • NPI 1548206907

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Granite Falls LTC, LLC

    dba Graham Healthcare and Rehabilitation Center

    • Skilled Nursing Facility
    • Robbinsville, NC
    • NPI 1366487464

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
  • Granite Falls LTC, LLC

    dba Macon Valley Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Franklin, NC
    • NPI 1457397952

    Principle It Services, Inc., Principle Long Term Care, Inc.

    CMS ownership
View all 43

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1255367447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 BALD HILL LOOP",
            "city": "MADISON",
            "state": "NC",
            "postal_code": "270257624",
            "telephone_number": "336-548-9658",
            "fax_number": "336-548-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 BALD HILL LOOP",
            "city": "MADISON",
            "state": "NC",
            "postal_code": "270257624",
            "telephone_number": "336-548-9658",
            "fax_number": "336-548-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE FALLS LTC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jacob's Creek Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jacob's Creek Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, NC

Sources for this page

Verify at the official NPI Registry.