Provider Demographics
NPI:1447204524
Name:THE GRACE VIEW MANOR NURSING HOME CORPORATION
Entity Type:Organization
Organization Name:THE GRACE VIEW MANOR NURSING HOME CORPORATION
Other - Org Name:PEARL AND EVERETT GILMOUR HEALTH CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-775-6400
Mailing Address - Street 1:88 CALVARY DR
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1031
Mailing Address - Country:US
Mailing Address - Phone:607-336-3915
Mailing Address - Fax:607-337-1026
Practice Address - Street 1:88 CALVARY DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1031
Practice Address - Country:US
Practice Address - Phone:607-336-3915
Practice Address - Fax:607-337-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0824301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01351468Medicaid
NY335759Medicare PIN
NY01351468Medicaid
NY335759Medicare Oscar/Certification