Organization
GRANDFATHER HOME - RALEIGH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM SWINKOLA MBA (CEO)
(828) 898-5465
Entity
Organization
Contact information
Practice address
5000 HOLLY RIDGE FARM RD, RALEIGH, NC 27616-6121
(828) 898-5465
(828) 898-6140
Mailing address
PO BOX 98, BANNER ELK, NC 28604-0098
(828) 898-5465
(828) 898-6140
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/06/2007
Last updated
08/08/2008
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