417 Mountain Trace LLC
Skilled Nursing Facility in Sylva, NC. Organization (NPI-2).
NPI number1760639199
StatusActive
Last updated in NPPESAug 27, 2008
Details
- NPI
- 1760639199
- Entity type
- Organization (NPI-2)
- Legal business name
- 417 Mountain Trace LLC
- Organization subpart
- No
- Enumeration date
- Aug 27, 2008
- Last updated
- Aug 27, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | – | – | Yes |
Other names
- Mountain Trace Nursing Center (Doing Business As)
Practice location
417 Mountain Trace RdSylva, NC 28779-6779
Phone 828-631-1600
Mailing address
417 Mountain Trace RdSylva, NC 28779-6779
Phone 828-631-1600
Authorized official
Abraham N/A Shaulson
President
3058649191
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