GRACEY MANOR LLC NPI 1194033894

NPI Information

NPI: 1194033894
Provider Name: GRACEY MANOR LLC
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
3400 YOUTH MONROE RD
LOGANVILLE, GA
ZIP 30052
Phone: (770) 466-1535
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GRACEY MANOR LLC is an assisted living facility in Loganville, GA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. GRACEY MANOR LLC NPI is 1194033894. The provider is registered as an organization entity type.

The provider's business location address is:

3400 YOUTH MONROE RD
LOGANVILLE, GA
ZIP 30052-327
Phone: (770) 466-1535

The provider's authorized official is Shaundell Blege .
The authorized official title is On Site Manager and has the following contact phone number (404) 889-7145.

The enumeration date for this NPI number is 9/16/2010 and was last updated on 9/16/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		147010191	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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