Healthcare Provider Details

I. General information

NPI: 1659319366
Provider Name (Legal Business Name): WALNUT COVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WINDMILL ST
WALNUT COVE NC
27052-7706
US

IV. Provider business mailing address

PO BOX 158
WALNUT COVE NC
27052-0158
US

V. Phone/Fax

Practice location:
  • Phone: 336-591-4353
  • Fax: 336-591-7659
Mailing address:
  • Phone: 336-591-4353
  • Fax: 336-591-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0316
License Number StateNC

VIII. Authorized Official

Name: TIM LEHNER
Title or Position: MANAGER
Credential:
Phone: 770-698-9040