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Organization
GRACELAND MANOR & ASSOCIATES, INC
Active
Organization
GRACELAND MANOR & ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELVA COLVIN (CEO)
(910) 488-8807
Entity
Organization
Contact information
Practice address
408 PELT DR, FAYETTEVILLE, NC 28301-3412
(910) 322-6855
Mailing address
PO BOX 35174, FAYETTEVILLE, NC 28303-0174
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL 026 654
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL 026 655
NC
320700000X
Physical Disabilities Residential Treatment Facility
Primary
FCL 026 026
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NULL
Other
Enumeration date
02/23/2007
Last updated
07/01/2010
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