Provider Demographics
NPI:1710087143
Name:MTN TRACE NURSING CENTER
Entity Type:Organization
Organization Name:MTN TRACE NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-7195
Mailing Address - Street 1:417 MOUNTAIN TRACE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-6779
Mailing Address - Country:US
Mailing Address - Phone:828-631-1600
Mailing Address - Fax:
Practice Address - Street 1:87 EASTGATE DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5171
Practice Address - Country:US
Practice Address - Phone:828-586-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0087314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405302Medicaid
NCBC NCOtherBC NC
NC3406484Medicaid
NC3406484Medicaid