NPIMap

Organization Active NPI

Graceson Manor Adult Care, LLC

  • Assisted Living Facility
  • Reidsville, NC
National Provider Identifier
1639440373
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
FCL-079-088 Issued in NC
Legal business name
GRACESON MANOR ADULT CARE, LLC
Practice address
5860 US 29 Bus
Reidsville, NC 27320-8973
Phone
(336) 349-3610
NPI assigned
Jan 25, 2012
Organization subpart
Yes
Parent organization
GRACESON MANOR ADULT CARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Authorized official

Name
Ms. Christy Gwynn
Title
Administrator
Phone
(336) 327-6284

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X FCL-079-088 NC Primary

Addresses

Primary practice location

5860 US 29 Bus
Reidsville, NC 27320-8973

Mailing address

PO Box 2361
Reidsville, NC 27323-2361
Phone (336) 327-6284

National Provider Directory

National Provider Directory
Tax ID family
Ashlee Place4 organizations share this tax ID, including this one
Part of
Ashlee Place

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1639440373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2361",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273232361",
            "telephone_number": "336-327-6284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5860 US 29 BUS",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273208973",
            "telephone_number": "336-349-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACESON MANOR ADULT CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRACESON MANOR ADULT CARE, LLC",
        "enumeration_date": "2012-01-25",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "GWYNN",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-327-6284",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-079-088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reidsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.