# TAR RIVER LTC GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Roanoke Landing Nursing and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285660787
- **Authorized official:** MS. KAREN G MCDANIEL (PRESIDENT)
- **Authorized official phone:** (252) 523-9094

## Contact information

- **Practice address:** 1084 US HIGHWAY 64 E, PLYMOUTH, NC 27962-9215
- **Practice address phone:** (252) 793-2100
- **Practice address fax:** (252) 793-1243
- **Mailing address:** 1084 US HIGHWAY 64 E, PLYMOUTH, NC 27962-9215
- **Mailing address phone:** (252) 793-2100
- **Mailing address fax:** (252) 793-1243

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0419 | NC | Yes |
| 385H00000X | Respite Care | NH0419 | NC | — |

## Other

- **Enumeration date:** 06/25/2006
- **Last updated:** 04/10/2017

## 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 |