1003595513 NPI number — GREGORY'S ASSISTED LIVING

Table of content: (NPI 1003595513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003595513 NPI number — GREGORY'S ASSISTED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY'S ASSISTED LIVING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003595513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 400
Provider Second Line Business Mailing Address:
29255 WALKER LANE
Provider Business Mailing Address City Name:
MEADOWVIEW
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-944-5350
Provider Business Mailing Address Fax Number:
276-695-9047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29255 WALKER LANE
Provider Second Line Business Practice Location Address:
29271 WALKER LANE
Provider Business Practice Location Address City Name:
MEADOWVIEW
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-793-5155
Provider Business Practice Location Address Fax Number:
276-695-9047
Provider Enumeration Date:
07/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT ADMINISTRATOR
Authorized Official Telephone Number:
386-793-5155

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1508026352 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: VA-1706-001300 . This is a "STATE LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: VA-1706-001300 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1706-001300 . This is a "BOARD OF NURSING, MEDICATION AID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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