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General NPI Number Information
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NPI Number | 1699763904
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Entity Type | Organization
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Legal Business Name | VALDESE NURSING HOME INC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 95 LOCUST ST
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City | CONNELLY SPRINGS
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State | NC
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Zip | 28612-8007
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Country | US
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Telephone | 828-580-6800
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Fax | 828-580-6803
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | VALDESE
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State | NC
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Zip | 28690-0250
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Country | US
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Telephone | 828-580-6800
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Fax | 828-580-6803
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT CFO
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Name | ROBERT FRITTS
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Credential |
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Telephone | 828-580-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0553
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License Number State | NC
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