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General NPI Number Information
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NPI Number | 1174590608
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Entity Type | Organization
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Legal Business Name | YADKIN NURSING CARE CENTER, INC.
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 903 W MAIN ST
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City | YADKINVILLE
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State | NC
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Zip | 27055-7807
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Country | US
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Telephone | 336-679-8863
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Fax | 336-679-3009
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Provider Business Mailing Address
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Address Line | PO BOX 879
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City | YADKINVILLE
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State | NC
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Zip | 27055-0879
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Country | US
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Telephone | 336-679-8863
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Fax | 336-679-3009
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. NICK ELLEDGE
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Credential |
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Telephone | 336-679-8852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | HAL-099-011
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License Number State | NC
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