Healthcare Provider Details

I. General information

NPI: 1558029488
Provider Name (Legal Business Name): SMOKEY RIDGE HEALTH AND REHABILITATION SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 PENSACOLA RD
BURNSVILLE NC
28714-3318
US

IV. Provider business mailing address

8 MELISSA LEE DR
JACKSON NJ
08527-5151
US

V. Phone/Fax

Practice location:
  • Phone: 828-682-9759
  • Fax:
Mailing address:
  • Phone: 617-875-8098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID FISCHER
Title or Position: COO
Credential:
Phone: 828-756-3600