# NC DEPARTMENT OF MILITARY AND VETERAN AFFAIRS NC DIVISION OF VET

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NC STATE VETERANS HOME KINSTON
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396087391
- **Authorized official:** LYNETHIA N HOLLEY (PROVIDER ENROLLMENT SPECIALIST)
- **Authorized official phone:** (770) 806-6875

## Contact information

- **Practice address:** 2150 HULL RD, KINSTON, NC 28504-2052
- **Practice address phone:** (252) 939-8000
- **Mailing address:** 4001 MAIL SERVICE CTR, RALEIGH, NC 27699-4001
- **Mailing address phone:** (984) 204-2982
- **Mailing address fax:** (984) 204-8344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NC0634 | NC | Yes |

## Other

- **Enumeration date:** 03/18/2013
- **Last updated:** 09/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | NH0634 | STATE OF NORTH CAROLINA LICENSURE | NC |