Provider Demographics
NPI:1497844302
Name:SYLVANGLADE HOME, INC.
Entity Type:Organization
Organization Name:SYLVANGLADE HOME, INC.
Other - Org Name:DONNELL GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-772-0952
Mailing Address - Street 1:4915 SYLVANGLADE ROAD
Mailing Address - Street 2:
Mailing Address - City:MCLEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301
Mailing Address - Country:US
Mailing Address - Phone:336-772-0952
Mailing Address - Fax:336-356-2156
Practice Address - Street 1:4915 SYLVANGLADE RD
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9753
Practice Address - Country:US
Practice Address - Phone:336-772-0952
Practice Address - Fax:336-356-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL0415723104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness