GRACE HEALTHCARE OF WINSTON SALEM (WINSTON SALEM HEALTHCARE LLC) NPI 1417137340

Skilled Nursing Facility in Winston Salem, NC

Organization Skilled Nursing Facility CLIA Number 34D1094967 CLIA Certificate of Waiver

About GRACE HEALTHCARE OF WINSTON SALEM (WINSTON SALEM HEALTHCARE LLC)

Grace Healthcare Of Winston Salem (winston Salem Healthcare Llc) is a provider established in Winston Salem, North Carolina specializing in skilled nursing facility. The NPI number of Grace Healthcare Of Winston Salem (winston Salem Healthcare Llc) is 1417137340 and was assigned on November 2007. The practitioner's primary taxonomy code is 314000000X with license number 923570 (NC). The provider is registered as an organization and their NPI record was last updated 12 years ago. The provider's is doing business as Grace Healthcare Of Winston Salem. The authorized official of this NPI record is Mrs. Alice Marie Clark Danks Cpa (Vp Of Finance)

The CLIA number of Grace Healthcare Of Winston Salem is 34D1094967 registered as a "skilled nursing/nursing facility" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Grace Healthcare Of Winston Salem to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1417137340

Provider NameGRACE HEALTHCARE OF WINSTON SALEM (WINSTON SALEM HEALTHCARE LLC)
Provider Location Address1900 W 1ST ST WINSTON SALEM, NC 27104
Provider Mailing Address1900 W 1ST ST WINSTON SALEM, NC 27104
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameGRACE HEALTHCARE OF WINSTON SALEM
Other Name TypeDoing Business As (3)
Enumeration Date11-08-2007
Last Update Date06-09-2008

Primary Taxonomy

Taxonomy Code314000000X
ClassificationSkilled Nursing Facility
TypeNursing & Custodial Care Facilities
License No.923570
License StateNC
Taxonomy Description(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

Business Address

GRACE HEALTHCARE OF WINSTON SALEM
1900 W 1ST ST
WINSTON SALEM, NC
ZIP 27104
Phone: (336) 724-2821
Fax: (336) 725-8314

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Mailing Address

GRACE HEALTHCARE OF WINSTON SALEM
1900 W 1ST ST
WINSTON SALEM, NC
ZIP 27104
Phone: (336) 724-2821
Fax: (336) 725-8314

Authorized Official

Authorized Official NameMRS. ALICE MARIE CLARK DANKS CPA
Authorized Official TitleVP OF FINANCE
Authorized Official Phone(423) 308-1845

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1417137340 is:

CLIA Number34D1094967
Facility TypeSKILLED NURSING/NURSING FACILITY
Certificate TypeCertificate of Waiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
3416540MEDICAID (05)NC
0345092MEDICAID (05)NC
345092MEDICARE OSCAR/CERTIFICATION (06)NC

Other Providers at the same location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1356617419HEALTHTIQUE WINSTON SALEM, LLC
Organization
Skilled Nursing Facility1900 W 1ST ST
WINSTON SALEM, NC 27104
(336) 724-2821
1457864142 ANNE MARIE PRAH FNP-BC
Individual
Nurse Practitioner (Family)1900 W 1ST ST
WINSTON SALEM, NC 27104
(336) 724-2821
1598321150 CHAD MARSHALL HOLSHOUSER
Individual
Occupational Therapy Assistant1900 W 1ST ST
WINSTON SALEM, NC 27104
(336) 724-2821
1669834347WINSTON SALEM REHAB OPERATIONS LLC
Organization
Skilled Nursing Facility1900 W 1ST ST
WINSTON SALEM, NC 27104
(336) 724-2821
1821551797CITADEL AT WINSTON SALEM LLC
Organization
Skilled Nursing Facility1900 W 1ST ST
WINSTON SALEM, NC 27104
(336) 724-2821
1891228839 LOU ANN EARNHARDT MSN, AGPCNP-BC
Individual
Nurse Practitioner (Adult Health)1900 W 1ST ST
WINSTON SALEM, NC 27104
(737) 226-6700
1902367196MR. NATHANIEL BAKER JR.
Individual
Occupational Therapy Assistant1900 W 1ST ST
WINSTON SALEM, NC 27104
(704) 701-3309

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.