417 Mountain Trace LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

417 MOUNTAIN TRACE LLC

Doing business as

Mountain Trace Nursing Center

Practice address

417 Mountain Trace Rd
Sylva, NC 28779-6779

Phone

(828) 631-1600

NPI assigned

Aug 27, 2008

Last updated

Aug 27, 2008By 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

Mr. Abraham N/a Shaulson, N/A

Title

President

Phone

(305) 864-9191

Specialties & licenses 1

Addresses

Other names 1

• Mountain Trace Nursing Center Doing business as

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219795200000",
    "number": "1760639199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 MOUNTAIN TRACE RD",
            "city": "SYLVA",
            "state": "NC",
            "postal_code": "287796779",
            "telephone_number": "828-631-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 MOUNTAIN TRACE RD",
            "city": "SYLVA",
            "state": "NC",
            "postal_code": "287796779",
            "telephone_number": "828-631-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "417 MOUNTAIN TRACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2008-08-27",
        "status": "A",
        "authorized_official_last_name": "SHAULSON",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_middle_name": "N/A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-864-9191",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "N/A"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Trace Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Sylva, NC
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• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.