NPIMap

Organization Active NPI

New Graceson Manor Adult Care

  • Adult Care Home Facility
  • Reidsville, NC
National Provider Identifier
1699212555
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
FCL079104 Issued in NC
Legal business name
NEW GRACESON MANOR ADULT CARE
Practice address
116 Gwynn Dr
Reidsville, NC 27320-8710
Phone
(336) 613-2319
Fax
(336) 342-4473
NPI assigned
Jan 30, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Mrs. Vernell M Simpson
Title
Administrator
Phone
(336) 613-2319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X FCL079104 NC Primary

Addresses

Primary practice location

116 Gwynn Dr
Reidsville, NC 27320-8710

Mailing address

186 Stockton Rd
Reidsville, NC 27320-8632
Phone (336) 613-2319

National Provider Directory

National Provider Directory
Tax ID family
New Graceson Manor Adult Care2 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.

NPI Registry JSON

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1699212555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 STOCKTON RD",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273208632",
            "telephone_number": "336-613-2319",
            "fax_number": "336-342-4473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 GWYNN DR",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273208710",
            "telephone_number": "336-613-2319",
            "fax_number": "336-342-4473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW GRACESON MANOR ADULT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-30",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "VERNELL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-613-2319",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL079104",
            "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 Nov 2, 2022; 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.