Provider Demographics
NPI:1407909377
Name:WATAUGA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WATAUGA MEDICAL CENTER, INC.
Other - Org Name:ARHS CAP AND AVERY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SYSTEM SERVICE LINES
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:BIANCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-266-1166
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657-0489
Mailing Address - Country:US
Mailing Address - Phone:828-733-1062
Mailing Address - Fax:828-733-5831
Practice Address - Street 1:358 BEECH ST
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-0489
Practice Address - Country:US
Practice Address - Phone:828-733-1062
Practice Address - Fax:828-733-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0826251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600299Medicaid