Healthcare Provider Details

I. General information

NPI: 1952396509
Provider Name (Legal Business Name): SOUTHEASTERN HEALTH FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BUCKNER BRANCH RD
BRYSON CITY NC
28713-6665
US

IV. Provider business mailing address

410 BUCKNER BRANCH RD
BRYSON CITY NC
28713-6665
US

V. Phone/Fax

Practice location:
  • Phone: 828-488-2101
  • Fax: 828-488-8502
Mailing address:
  • Phone: 828-488-2101
  • Fax: 828-488-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0251
License Number StateNC

VIII. Authorized Official

Name: MR. RONALD V. SMITH
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 828-488-2101