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Organization
TAR RIVER LTC GROUP, LLC
Active
Organization
TAR RIVER LTC GROUP, LLC
Active
Other names
Roanoke Landing Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN G MCDANIEL (PRESIDENT)
(252) 523-9094
Entity
Organization
Contact information
Practice address
1084 US HIGHWAY 64 E, PLYMOUTH, NC 27962-9215
(252) 793-2100
(252) 793-1243
Mailing address
1084 US HIGHWAY 64 E, PLYMOUTH, NC 27962-9215
(252) 793-2100
(252) 793-1243
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0419
NC
385H00000X
Respite Care
NH0419
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0085E
BC/BS OF NC
NC
05
—
3435266
—
NC
05
—
3436404
—
NC
05
—
3445266
—
NC
05
—
7806621
—
NC
Enumeration date
06/25/2006
Last updated
04/10/2017
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