# RV NURSING HOME, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Rich Square Health Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336216779
- **Authorized official:** MR. JAMES T JOHNSON JR. (OWNER)
- **Authorized official phone:** (252) 209-6834

## Contact information

- **Practice address:** 320 NORTH MAIN STREET, RICH SQUARE, NC 27869-0560
- **Practice address phone:** (252) 539-4161
- **Practice address fax:** (252) 539-4361
- **Mailing address:** 320 NORTH MAIN STREET, P O BOX 560, RICH SQUARE, NC 27869-0560
- **Mailing address phone:** (252) 539-4161
- **Mailing address fax:** (252) 539-4361

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0045 | NC | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 07/16/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3425356 | — | NC |
| 05 | — | 3426020 | — | NC |
| 01 | — | 923433 | FACILITY ID NUMBER | NC |