Provider Demographics
NPI:1356852511
Name:GRACE CLINIC OF YADKIN VALLEY
Entity Type:Organization
Organization Name:GRACE CLINIC OF YADKIN VALLEY
Other - Org Name:TRI-COUNTY HEALTH RESOURCE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-835-1467
Mailing Address - Street 1:PO BOX 978
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-0978
Mailing Address - Country:US
Mailing Address - Phone:336-835-1467
Mailing Address - Fax:336-835-1469
Practice Address - Street 1:948 JOHNSON RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-0948
Practice Address - Country:US
Practice Address - Phone:336-835-1467
Practice Address - Fax:336-835-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty