Healthcare Provider Details

I. General information

NPI: 1699070094
Provider Name (Legal Business Name): REALITY RESIDENTIAL BLACK MTN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 MONTREAT RD
BLACK MTN NC
28711-3232
US

IV. Provider business mailing address

PO BOX 2169
CANDLER NC
28715-2169
US

V. Phone/Fax

Practice location:
  • Phone: 828-669-8921
  • Fax: 828-669-1545
Mailing address:
  • Phone: 828-669-8921
  • Fax: 828-669-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-011-309
License Number StateNC

VIII. Authorized Official

Name: MR. WITTNER EUGENE WRIGHT
Title or Position: OWNER
Credential:
Phone: 828-216-7475