Provider Demographics
NPI:1437210515
Name:GRAYSON HOUSING INCORPORATED
Entity Type:Organization
Organization Name:GRAYSON HOUSING INCORPORATED
Other - Org Name:GRAYSON MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:270-259-4028
Mailing Address - Street 1:505 WILLIAM THOMASON BYWAY
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1419
Mailing Address - Country:US
Mailing Address - Phone:270-259-4028
Mailing Address - Fax:270-259-2417
Practice Address - Street 1:505 WILLIAM THOMASON BYWAY
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1419
Practice Address - Country:US
Practice Address - Phone:270-259-4028
Practice Address - Fax:270-259-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100150314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501417Medicaid
KY12501417Medicaid