Provider Demographics
NPI:1376926519
Name:GRANITE FALLS HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:GRANITE FALLS HEALTH AND REHABILITATION, LLC
Other - Org Name:HICKORY FALLS HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-608-9123
Mailing Address - Street 1:229 AIRPORT RD
Mailing Address - Street 2:SUITE 7-104
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-6402
Mailing Address - Country:US
Mailing Address - Phone:919-608-9123
Mailing Address - Fax:919-882-9771
Practice Address - Street 1:100 SUNSET ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1770
Practice Address - Country:US
Practice Address - Phone:828-396-2387
Practice Address - Fax:828-396-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0380314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406330Medicaid
NC3405246Medicaid
NC3406330Medicaid