Healthcare Provider Details

I. General information

NPI: 1043123359
Provider Name (Legal Business Name): BETTYS HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2572 RIDGEVIEW DR
VALDESE NC
28690-9573
US

IV. Provider business mailing address

2572 RIDGEVIEW DR
VALDESE NC
28690-9573
US

V. Phone/Fax

Practice location:
  • Phone: 828-443-7792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONNIE VAUGHN PUETT
Title or Position: MEMBER /ADMINISTRATOR
Credential:
Phone: 828-443-7792