Basic Information
| Provider Information | |||||||||
| NPI: | 1457590838 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GROVE AL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WINDSOR ASSISTED LIVING AND MEMORY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2568 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286032568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282617335 | ||||||||
| FaxNumber: | 8283268115 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 GROVE AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232212202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043533881 | ||||||||
| FaxNumber: | 8283268115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2009 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | LEO | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 8282617335 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | CLO-08-1104033 | VA | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.