Provider Demographics
NPI:1326433079
Name:GRACELAND NURSING LLC
Entity Type:Organization
Organization Name:GRACELAND NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LANKRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-332-7380
Mailing Address - Street 1:1250 FARROW RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7116
Mailing Address - Country:US
Mailing Address - Phone:901-332-7290
Mailing Address - Fax:901-332-7380
Practice Address - Street 1:368 NEW HEMPSTEAD RD
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1900
Practice Address - Country:US
Practice Address - Phone:718-338-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
445331Medicare Oscar/Certification