MEDICARE: VALDESE NURSING HOME

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	7801132	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	:	1689716292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALDESE NURSING HOME

Provider Business Mailing Address
First Line	:	PO BOX 250
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-0250
Country	:	US
Telephone Number	:	828-580-6800
Fax Number	:	828-580-6803

Provider Business Practice Location Address
First Line	:	95 LOCUST ST
Second Line	:
City	:	CONNELLY SPRINGS
State	:	NC
Zip	:	28612-8007
Country	:	US
Telephone Number	:	828-580-6800
Fax Number	:	828-580-6803

Authorized Official
Title or Position	:	ADMINISTRATORS
Name	:	MR. ROBERT G FRITTS
Credential	:
Telephone Number	:	828-580-5545

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	02/06/2012

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Directions to “VALDESE NURSING HOME ” Practice Location

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