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Organization
GRACEY MANOR LLC
Active
Organization
GRACEY MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAUNDELL BLEGE (ON SITE MANAGER)
(404) 889-7145
Entity
Organization
Contact information
Practice address
3400 YOUTH MONROE RD, LOGANVILLE, GA 30052-4327
(770) 466-1535
Mailing address
3400 YOUTH MONROE RD, LOGANVILLE, GA 30052-4327
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
147010191
GA
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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