Provider Demographics
NPI:1669408969
Name:GRANITE FALLS LTC, LLC
Entity type:Organization
Organization Name:GRANITE FALLS LTC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:PO BOX 561869
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28256-1869
Mailing Address - Country:US
Mailing Address - Phone:704-549-0807
Mailing Address - Fax:704-548-8413
Practice Address - Street 1:9200 GLENWATER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8557
Practice Address - Country:US
Practice Address - Phone:704-549-0807
Practice Address - Fax:704-548-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0016314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415142Medicaid
NC3425142Medicaid
NC7801034Medicaid
NC24367OtherPARTNERS INSURANCE
NC0096QOtherBC/BS OF NC
NC3425142Medicaid
NC3425142Medicaid