# NEW GRACESON MANOR ADULT CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699212555
- **Authorized official:** MRS. VERNELL M SIMPSON (ADMINISTRATOR)
- **Authorized official phone:** (336) 613-2319

## Contact information

- **Practice address:** 116 GWYNN DR, REIDSVILLE, NC 27320-8710
- **Practice address phone:** (336) 613-2319
- **Practice address fax:** (336) 342-4473
- **Mailing address:** 186 STOCKTON RD, REIDSVILLE, NC 27320-8632
- **Mailing address phone:** (336) 613-2319
- **Mailing address fax:** (336) 342-4473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL079104 | NC | Yes |

## Other

- **Enumeration date:** 01/30/2017
- **Last updated:** 11/02/2022