Organization
GRACESON MANOR
Active
Organization
GRACESON MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA L GWYNN (OWNER/ADMINISTRATOR)
(336) 349-3610
Entity
Organization
Contact information
Practice address
116 GWYNN DR, REIDSVILLE, NC 27320-8710
(336) 349-2806
Mailing address
116 GWYNN DR, REIDSVILLE, NC 27320-8710
(336) 349-2806
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL-079-054
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7805575
EDS NUMBER
NC
Enumeration date
08/30/2006
Last updated
05/20/2008
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