Provider Demographics
NPI:1003595513
Name:GREGORY'S ASSISTED LIVING
Entity Type:Organization
Organization Name:GREGORY'S ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, RMA
Authorized Official - Phone:386-793-5155
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:29255 WALKER LANE
Mailing Address - City:MEADOWVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24361
Mailing Address - Country:US
Mailing Address - Phone:276-944-5350
Mailing Address - Fax:276-695-9047
Practice Address - Street 1:29255 WALKER LANE
Practice Address - Street 2:29271 WALKER LANE
Practice Address - City:MEADOWVIEW
Practice Address - State:VA
Practice Address - Zip Code:24361
Practice Address - Country:US
Practice Address - Phone:386-793-5155
Practice Address - Fax:276-695-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508026352Medicaid
VAVA-1706-001300OtherSTATE LICENSE
VAVA-1706-001300Medicaid
VA1706-001300OtherBOARD OF NURSING, MEDICATION AID