Provider Demographics
NPI:1407803679
Name:CLAY COUNTY HEALTHCARE LLC
Entity Type:Organization
Organization Name:CLAY COUNTY HEALTHCARE LLC
Other - Org Name:CLAY COUNTY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:86 VALLEY HIDEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-9674
Mailing Address - Country:US
Mailing Address - Phone:828-389-9941
Mailing Address - Fax:828-389-3712
Practice Address - Street 1:86 VALLEY HIDEAWAY DR
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-9674
Practice Address - Country:US
Practice Address - Phone:828-389-9941
Practice Address - Fax:828-389-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0542314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1407803679Medicaid
NC3425433Medicaid
NC342604NMedicaid
NC3425433Medicaid
345433AMedicare Oscar/Certification