Provider Demographics
NPI:1588660492
Name:WATAUGA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WATAUGA MEDICAL CENTER, INC.
Other - Org Name:ARHS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SYSTEM SERVICE LINES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:BIANCA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-266-1166
Mailing Address - Street 1:PO BOX 2528
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-2528
Mailing Address - Country:US
Mailing Address - Phone:828-266-1166
Mailing Address - Fax:828-262-0156
Practice Address - Street 1:155 FURMAN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5049
Practice Address - Country:US
Practice Address - Phone:828-266-1166
Practice Address - Fax:828-262-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1544251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407225Medicaid
NC3407225Medicaid