Provider Demographics
NPI:1093708497
Name:SILVER BLUFF LLC
Entity Type:Organization
Organization Name:SILVER BLUFF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEATHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-648-2044
Mailing Address - Street 1:100 SILVER BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-6350
Mailing Address - Country:US
Mailing Address - Phone:828-648-2044
Mailing Address - Fax:828-648-2065
Practice Address - Street 1:100 SILVER BLUFF DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-6350
Practice Address - Country:US
Practice Address - Phone:828-648-2044
Practice Address - Fax:828-648-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0458314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405341Medicaid
NC3406458Medicaid
NC3406458Medicaid