Provider Demographics
NPI:1952396509
Name:SOUTHEASTERN HEALTH FACILITIES
Entity Type:Organization
Organization Name:SOUTHEASTERN HEALTH FACILITIES
Other - Org Name:MOUNTAIN VIEW MANOR NSG. CTR.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:828-488-2101
Mailing Address - Street 1:410 BUCKNER BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-6665
Mailing Address - Country:US
Mailing Address - Phone:828-488-2101
Mailing Address - Fax:828-488-8502
Practice Address - Street 1:410 BUCKNER BRANCH RD
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-6665
Practice Address - Country:US
Practice Address - Phone:828-488-2101
Practice Address - Fax:828-488-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0251314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00884OtherBLUE CROSS & BLUE SHIELD
NC3405193Medicaid
NC3405193Medicaid