Provider Demographics
NPI:1306199617
Name:CAYLEE PLACE
Entity Type:Organization
Organization Name:CAYLEE PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:GWYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-349-3610
Mailing Address - Street 1:PO BOX 2361
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-2361
Mailing Address - Country:US
Mailing Address - Phone:336-349-3610
Mailing Address - Fax:336-342-4473
Practice Address - Street 1:538 WARRINER ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3053
Practice Address - Country:US
Practice Address - Phone:336-394-4403
Practice Address - Fax:336-342-4473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACESON MANOR ADULT CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-079-091310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility