Provider Demographics
NPI:1861504946
Name:SNOWSHOE LTC GROUP, LLC
Entity Type:Organization
Organization Name:SNOWSHOE LTC GROUP, LLC
Other - Org Name:SMOKY MOUNTAIN HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:1349 CRABTREE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-7315
Mailing Address - Country:US
Mailing Address - Phone:828-627-2789
Mailing Address - Fax:828-627-9825
Practice Address - Street 1:1349 CRABTREE RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28785-7315
Practice Address - Country:US
Practice Address - Phone:828-627-2789
Practice Address - Fax:828-627-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0342314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415396Medicaid
NC3405396Medicaid
NC3405396Medicaid
NC3406278Medicaid