Provider Demographics
NPI:1851449136
Name:GRANVILLE HOUSE
Entity Type:Organization
Organization Name:GRANVILLE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-692-1315
Mailing Address - Street 1:200 COVENTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565
Mailing Address - Country:US
Mailing Address - Phone:919-692-1315
Mailing Address - Fax:919-692-1363
Practice Address - Street 1:200 COVENTRY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-4005
Practice Address - Country:US
Practice Address - Phone:919-692-1315
Practice Address - Fax:919-692-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL- 039-009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804060OtherPROVIDER NUMBER