# 417 MOUNTAIN TRACE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mountain Trace Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760639199
- **Authorized official:** MR. ABRAHAM N/A SHAULSON N/A (PRESIDENT)
- **Authorized official phone:** (305) 864-9191

## Contact information

- **Practice address:** 417 MOUNTAIN TRACE RD, SYLVA, NC 28779-6779
- **Practice address phone:** (828) 631-1600
- **Mailing address:** 417 MOUNTAIN TRACE RD, SYLVA, NC 28779-6779
- **Mailing address phone:** (828) 631-1600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/27/2008
- **Last updated:** 08/27/2008