Provider Demographics
NPI:1699763904
Name:VALDESE NURSING HOME INC
Entity type:Organization
Organization Name:VALDESE NURSING HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-580-5545
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-0250
Mailing Address - Country:US
Mailing Address - Phone:828-580-6800
Mailing Address - Fax:828-580-6803
Practice Address - Street 1:95 LOCUST ST
Practice Address - Street 2:
Practice Address - City:CONNELLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612-8007
Practice Address - Country:US
Practice Address - Phone:828-580-6800
Practice Address - Fax:828-580-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0553314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0090POtherBCBS NC PROVIDER
NC923110OtherFACILITY ID NUMBER
NC3405446Medicaid
NC340606AMedicaid
NC0090POtherBCBS NC PROVIDER