Provider Demographics
NPI:1699212555
Name:NEW GRACESON MANOR ADULT CARE
Entity Type:Organization
Organization Name:NEW GRACESON MANOR ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERNELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-613-2319
Mailing Address - Street 1:186 STOCKTON RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8632
Mailing Address - Country:US
Mailing Address - Phone:336-613-2319
Mailing Address - Fax:336-342-4473
Practice Address - Street 1:116 GWYNN DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8710
Practice Address - Country:US
Practice Address - Phone:336-613-2319
Practice Address - Fax:336-342-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL079104311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home