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NPI Code Detail

MEDICARE: CANTON CHRISTIAN CONVALESCENT CENTER, LLC

MEDICARE: CANTON CHRISTIAN CONVALESCENT CENTER, 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
1314000000XSkilled Nursing FacilityNH0081NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730175985
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANTON CHRISTIAN CONVALESCENT CENTER, LLC
Provider Business Mailing Address
First Line : 75 FISHER LOOP
Second Line :
City : MAGGIE VALLEY
State : NC
Zip : 28751-5531
Country : US
Telephone Number : 828-566-3002
Fax Number : 828-648-3551
Provider Business Practice Location Address
First Line : 75 FISHER LOOP
Second Line :
City : MAGGIE VALLEY
State : NC
Zip : 28751-5531
Country : US
Telephone Number : 828-566-3002
Fax Number : 828-648-0201
Authorized Official
Title or Position : MANAGER
Name : MR. CHARLES E TREFZGER JR.
Credential :
Telephone Number : 828-322-5535
Provider Enumeration Date : 09/23/2005
Last Update Date : 11/08/2011

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Directions to “CANTON CHRISTIAN CONVALESCENT CENTER, LLC ” Practice Location

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