Provider Demographics
NPI:1336302579
Name:GRANVILLE HEALTH SYSTEM
Entity type:Organization
Organization Name:GRANVILLE HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-690-3237
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0947
Mailing Address - Country:US
Mailing Address - Phone:919-690-3000
Mailing Address - Fax:919-603-1097
Practice Address - Street 1:1038 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2507
Practice Address - Country:US
Practice Address - Phone:919-690-3000
Practice Address - Fax:919-603-1097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANVILLE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-08
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
NC311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408994Medicaid