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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