Provider Demographics
NPI:1508041310
Name:GRANITE FALLS LTC, LLC
Entity Type:Organization
Organization Name:GRANITE FALLS LTC, LLC
Other - Org Name:GRAHAM HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORWOOD
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:UZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-1147
Mailing Address - Country:US
Mailing Address - Phone:828-479-8421
Mailing Address - Fax:828-479-4269
Practice Address - Street 1:811 SNOWBIRD RD
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-8103
Practice Address - Country:US
Practice Address - Phone:828-479-8421
Practice Address - Fax:828-479-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0495313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806626Medicaid
NC7803622Medicaid