Basic Information
| Provider Information | |||||||||
| NPI: | 1376926519 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRANITE FALLS HEALTH AND REHABILITATION, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HICKORY FALLS HEALTH AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 AIRPORT RD | ||||||||
| Address2: | SUITE 7-104 | ||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287046402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196089123 | ||||||||
| FaxNumber: | 9198829771 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SUNSET ST | ||||||||
| Address2: | |||||||||
| City: | GRANITE FALLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286301770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283962387 | ||||||||
| FaxNumber: | 8283969578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | SPRENGER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9196089123 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0380 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 3406330 | 05 | NC | MEDICAID | 3405246 | 05 | NC | MEDICAID |