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Organization
NC DEPT OF MILTARY AND VETERANS AFFAIRS NC DIVISION OF VETERAN AFF
Active
Organization
NC DEPT OF MILTARY AND VETERANS AFFAIRS NC DIVISION OF VETERAN AFF
Active
Other names
NC STATE VETERANS HOME - BLACK MTN
Organization subpart
No
Provider details
NPI number
Authorized official
LYNETHIA N HOLLEY (PROVIDER ENROLLMENT SPEC)
(770) 806-6875
Entity
Organization
Contact information
Practice address
62 LAKE EDEN ROAD, BLACK MOUNTAIN, NC 28711-8706
(828) 257-6800
(919) 807-4266
Mailing address
4001 MAIL SERVICE CENTER, RALEIGH, NC 27699-4000
(828) 257-6800
(984) 204-8344
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0631
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NH0631
STATE OF NORTH CAROLINA LICENSURE -
NC
Enumeration date
10/01/2012
Last updated
07/24/2025
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