Sylvanglade Home, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

MHL041572 Issued in NC

Legal business name

SYLVANGLADE HOME, INC.

Doing business as

Donnell Group Home

Practice address

4915 Sylvanglade Rd
MC Leansville, NC 27301-9753

Phone

(336) 772-0952

Fax

(336) 356-2156

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Hattie Graves

Title

Owner

Phone

(336) 772-0952

Specialties & licenses 1

Addresses

Other names 1

• Donnell Group Home Doing business as

Tax ID family

Donnell Group Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Sylvanglade Home, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • MC Leansville, NC
  • NPI 1629273610
  NPD tax ID

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497844302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 SYLVANGLADE ROAD",
            "city": "MCLEANSVILLE",
            "state": "NC",
            "postal_code": "27301",
            "telephone_number": "336-772-0952",
            "fax_number": "336-356-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 SYLVANGLADE RD",
            "city": "MC LEANSVILLE",
            "state": "NC",
            "postal_code": "273019753",
            "telephone_number": "336-772-0952",
            "fax_number": "336-356-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYLVANGLADE HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "HATTIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-772-0952",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NC",
            "license": "MHL041572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Donnell Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tabetha Snow
• Ava Laverne Stevenson, MA, LACS-A
• Sylvanglade Home, Inc.
• Tarheelbluetransportation LLC
• The Moses H Cone Memorial Hospital Operating Corporation
• The Turning Pointe Healthcare Services, LLC
• TLC Support & Habitation

• Assisted Living Facility (Mental Illness) in MC Leansville, NC
• Providers in MC Leansville, NC by specialty
• Assisted Living Facility (Mental Illness) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.