Grandfather Home - Raleigh

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

GRANDFATHER HOME - RALEIGH

Practice address

5000 Holly Ridge Farm Rd
Raleigh, NC 27616-6121

Phone

(828) 898-5465

Fax

(828) 898-6140

NPI assigned

Dec 6, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jim Swinkola, MBA

Title

Ceo

Phone

(828) 898-5465

Specialties & licenses 1

Addresses

Tax ID family

Grandfather Home - Raleigh2 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.

• Grandfather Home Community Services for Children

  • Mental Illness Community Based Residential Treatment Facility
  • Winston Salem, NC
  • NPI 1588721591
  NPD tax ID

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

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218153600000",
    "number": "1629251293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98",
            "city": "BANNER ELK",
            "state": "NC",
            "postal_code": "286040098",
            "telephone_number": "828-898-5465",
            "fax_number": "828-898-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HOLLY RIDGE FARM RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276166121",
            "telephone_number": "828-898-5465",
            "fax_number": "828-898-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDFATHER HOME - RALEIGH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2008-08-08",
        "status": "A",
        "authorized_official_last_name": "SWINKOLA",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "828-898-5465",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zhen Graham
• Juan Luis Granados, M.D.
• Sarah Lyn Granahan, HTP-A, RMT
• Grand Cypress Court Afl Home LLC
• Jeffrey S Grande, PA-C
• Deborah Granick, LCSW, RN, PMHNP
• Andre Grant, MD
• Antoinette Grant
• Crystal Adraine Grant, MS
• Devin Kyle Grant, D.P.M.

• Mental Illness Community Based Residential Treatment Facility in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; 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.