Organization
GRACEMORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM C. DAVIS JR. (PRESIDENT)
(478) 988-1294
Entity
Organization
Contact information
Practice address
2708 LEE ST, BRUNSWICK, GA 31520-4932
(912) 265-6771
(912) 264-8988
Mailing address
1211 MACON RD, STE D, PERRY, GA 31069-2679
(478) 988-1294
(478) 988-1193
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10631320
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000141182A
—
GA
05
—
000141182B
—
GA
Enumeration date
10/18/2005
Last updated
04/13/2012
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