Provider Demographics
NPI:1457590838
Name:GROVE AL, LLC
Entity Type:Organization
Organization Name:GROVE AL, LLC
Other - Org Name:WINDSOR ASSISTED LIVING AND MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-261-7335
Mailing Address - Street 1:PO BOX 2568
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2568
Mailing Address - Country:US
Mailing Address - Phone:828-261-7335
Mailing Address - Fax:828-326-8115
Practice Address - Street 1:3600 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2202
Practice Address - Country:US
Practice Address - Phone:804-353-3881
Practice Address - Fax:828-326-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACLO-08-1104033310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility