Provider Demographics
NPI:1407256886
Name:GRACELAND CARE HOMES INC.
Entity Type:Organization
Organization Name:GRACELAND CARE HOMES INC.
Other - Org Name:GRACELAND CARE HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:RICCI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-961-4805
Mailing Address - Street 1:1147 NE NEWPORT HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-9588
Mailing Address - Country:US
Mailing Address - Phone:541-961-4805
Mailing Address - Fax:541-264-8219
Practice Address - Street 1:1147 NE NEWPORT HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-9588
Practice Address - Country:US
Practice Address - Phone:541-961-4805
Practice Address - Fax:541-264-8219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICCI L BROWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR519910311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR542207984AMedicare Oscar/Certification