MEDICARE: YADKIN NURSING CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	HAL-099-011	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174590608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YADKIN NURSING CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 879
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-0879
Country	:	US
Telephone Number	:	336-679-8863
Fax Number	:	336-679-3009

Provider Business Practice Location Address
First Line	:	903 W MAIN ST
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7807
Country	:	US
Telephone Number	:	336-679-8863
Fax Number	:	336-679-3009

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. NICK ELLEDGE
Credential	:
Telephone Number	:	336-679-8852

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	08/22/2020

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