Grand Anne Residences, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

1952 Issued in VA

Legal business name

GRAND ANNE RESIDENCES, LLC

Practice address

2104 Walnut Ave
Buena Vista, VA 24416-2738

Phone

(540) 261-2222

Fax

(540) 261-2222

NPI assigned

Feb 18, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Deborah Z Shafer, QRMP

Title

Executive Director

Phone

(540) 261-2222

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1361145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361145600000",
    "number": "1568702256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 WALNUT AVE",
            "city": "BUENA VISTA",
            "state": "VA",
            "postal_code": "244162738",
            "telephone_number": "540-261-2222",
            "fax_number": "540-261-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 WALNUT AVE",
            "city": "BUENA VISTA",
            "state": "VA",
            "postal_code": "244162738",
            "telephone_number": "540-261-2222",
            "fax_number": "540-261-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ANNE RESIDENCES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-18",
        "last_updated": "2013-02-18",
        "status": "A",
        "authorized_official_last_name": "SHAFER",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "540-261-2222",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "QRMP"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "1952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DBHDS",
            "identifier": "1952",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Fix
• Juliet Dacal Gibson, ED.S.
• GL Virginia Shenandoah, LLC
• Joan Klein Godfrey, SLP
• Marian Gowdy, ATC
• Thomas Francis Hamilton, M.D.
• Lindsay Harper, ATC
• Kelli Hatcher, PT
• Amy K. W. Hevener, PT, DPT, FMSC
• Katlyn Devon Hickman, LBA

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Buena Vista, VA
• Providers in Buena Vista, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; 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.