Provider Demographics
NPI:1750305033
Name:GRAYSON FACILITY OPERATIONS, LLC
Entity Type:Organization
Organization Name:GRAYSON FACILITY OPERATIONS, LLC
Other - Org Name:GRAYSON REHABILITATION AND HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348-0857
Mailing Address - Country:US
Mailing Address - Phone:276-773-0303
Mailing Address - Fax:276-773-0404
Practice Address - Street 1:400 S. INDEPENDENCE AVENUE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348-3857
Practice Address - Country:US
Practice Address - Phone:276-773-0303
Practice Address - Fax:276-773-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750305033Medicaid
VA1750305033Medicaid