Provider Demographics
NPI:1952337073
Name:GRANITE FALLS LTC, LLC
Entity Type:Organization
Organization Name:GRANITE FALLS LTC, LLC
Other - Org Name:MAGNOLIA LANE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
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 1:107 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4505
Mailing Address - Country:US
Mailing Address - Phone:828-437-8760
Mailing Address - Fax:828-437-5336
Practice Address - Street 1:107 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4505
Practice Address - Country:US
Practice Address - Phone:828-437-8760
Practice Address - Fax:828-437-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0343314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3425219Medicaid
NC7108232OtherUNITED HEALTHCARE #
NC0090TOtherBC/BS OF NC
NC3415219Medicaid
NC345219Medicare PIN
NC3415219Medicaid