Provider Demographics
NPI:1588642102
Name:ARCHDALE NURSING CENTER, INC.
Entity Type:Organization
Organization Name:ARCHDALE NURSING CENTER, INC.
Other - Org Name:THE GRAYBRIER NURSING & RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER/ASSIST. ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:336-431-8888
Mailing Address - Street 1:116 LANE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-9343
Mailing Address - Country:US
Mailing Address - Phone:336-431-8888
Mailing Address - Fax:336-431-9053
Practice Address - Street 1:116 LANE DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:NC
Practice Address - Zip Code:27370-9343
Practice Address - Country:US
Practice Address - Phone:336-431-8888
Practice Address - Fax:336-431-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0489311ZA0620X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801536Medicaid
NC3405330Medicaid
NC3405330Medicaid