Healthcare Provider Details

I. General information

NPI: 1689716292
Provider Name (Legal Business Name): VALDESE NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 LOCUST ST
CONNELLY SPRINGS NC
28612-8007
US

IV. Provider business mailing address

PO BOX 250
VALDESE NC
28690-0250
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-6800
  • Fax: 828-580-6803
Mailing address:
  • Phone: 828-580-6800
  • Fax: 828-580-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number7801132
License Number StateNC

VIII. Authorized Official

Name: MR. ROBERT G FRITTS
Title or Position: ADMINISTRATORS
Credential:
Phone: 828-580-5545