NC Dept of Miltary and Veterans Affairs NC Division of Veteran Aff

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0631 Issued in NC

Legal business name

NC DEPT OF MILTARY AND VETERANS AFFAIRS NC DIVISION OF VETERAN AFF

Doing business as

NC State Veterans Home - Black MTN

Practice address

62 Lake Eden Road
Black Mountain, NC 28711-8706

Phone

(828) 257-6800

Fax

(919) 807-4266

NPI assigned

Oct 1, 2012

Last updated

Jul 24, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lynethia N Holley

Title

Provider Enrollment Spec

Phone

(770) 806-6875

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NC STATE VETERANS HOME - BLACK MTN Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578814588. Details of each certification follow.

• CCN 345558 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 345558

Legal name

NC DEPT OF MILTARY AND VETERANS AFFAIRS NC DIVISION OF VETERAN AFF

Doing business as

NC STATE VETERANS HOME - BLACK MTN

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 20, 2013

Last certification

Sep 5, 2024

Beds

100

Ownership / control type

Corporation

Multi-facility organization

Pruitt Health

Organization structure

GovernmentNon-profit

Enrollment address

62 Lake Eden Rd
Black Mountain, NC 28711-8706

Nursing home name

NC STATE VETERANS HOME - BLACK MOUNTAIN

Affiliated entity

PRUITTHEALTH

Listed as

NC State Veterans Home - Black MountainCCN 345558 · All quality measures

Overall star rating

5 of 5

Health inspections

3 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Feb 20, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

10082.3 residents per day on average

Chain

Pruitthealth95 facilities in the chain

Penalties (3 years)

1Fines totaling $12,759

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Rabi D Kutob, MD

  • Family Medicine Physician
  • Asheville, NC
  • NPI 1306807672

  Adp of the SNF

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Rabi D Kutob, MD

  • Family Medicine Physician
  • Asheville, NC
  • NPI 1306807672

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1578814588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 MAIL SERVICE CENTER",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276994000",
            "telephone_number": "828-257-6800",
            "fax_number": "984-204-8344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 LAKE EDEN ROAD",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287118706",
            "telephone_number": "828-257-6800",
            "fax_number": "919-807-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NC DEPT OF MILTARY AND VETERANS AFFAIRS NC DIVISION OF VETERAN AFF",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "LYNETHIA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPEC",
        "authorized_official_telephone_number": "770-806-6875"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF NORTH CAROLINA LICENSURE -",
            "identifier": "NH0631",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NC STATE VETERANS HOME - BLACK MTN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Black Mountain, NC
• Providers in Black Mountain, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.