Provider Demographics
NPI:1336193374
Name:GRAY'S NURSING HOME, INC
Entity Type:Organization
Organization Name:GRAY'S NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:REWEY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:608-349-6741
Mailing Address - Street 1:555 N CHESTNUT ST
Mailing Address - Street 2:P O BOX 512
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-2105
Mailing Address - Country:US
Mailing Address - Phone:608-349-6741
Mailing Address - Fax:608-349-6005
Practice Address - Street 1:555 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-2105
Practice Address - Country:US
Practice Address - Phone:608-349-6741
Practice Address - Fax:608-349-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2729314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20100600Medicaid
WI20100600Medicaid