Provider Demographics
NPI: | 1942561527 |
---|---|
Name: | GRANT ADULT CARE HOMES, INC. |
Entity Type: | Organization |
Organization Name: | GRANT ADULT CARE HOMES, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/ADMINISTRATOR |
Authorized Official - Prefix: | MISS |
Authorized Official - First Name: | ANNETTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARPER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSW |
Authorized Official - Phone: | 704-365-1504 |
Mailing Address - Street 1: | 3613 HAVENWOOD RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28205-4724 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-365-1504 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3613 HAVENWOOD RD |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28205-4724 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-365-1504 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-05-31 |
Last Update Date: | 2012-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 060-071 | 311ZA0620X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |