MEDICARE: NHC HEALTHCARE/KINGS MOUNTAIN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1699511063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NHC HEALTHCARE/KINGS MOUNTAIN, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1398
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37133-1398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 SIPES ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2716
Country	:	US
Telephone Number	:	704-739-8132
Fax Number	:

Authorized Official
Title or Position	:	MANAGER OF LLC
Name	:	ROBERT MICHAEL USSERY
Credential	:
Telephone Number	:	615-890-2020

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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