Provider Demographics
NPI:1558029488
Name:SMOKEY RIDGE HEALTH AND REHABILITATION SNF LLC
Entity Type:Organization
Organization Name:SMOKEY RIDGE HEALTH AND REHABILITATION SNF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-756-3600
Mailing Address - Street 1:8 MELISSA LEE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5151
Mailing Address - Country:US
Mailing Address - Phone:617-875-8098
Mailing Address - Fax:
Practice Address - Street 1:310 PENSACOLA RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3318
Practice Address - Country:US
Practice Address - Phone:828-682-9759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility