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Organization
TAR RIVER LTC GROUP, LLC
Active
Organization
TAR RIVER LTC GROUP, LLC
Active
Other names
Colony Ridge Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NORWOOD RANDOLPH UZZELL (PRESIDENT)
(252) 523-9094
Entity
Organization
Contact information
Practice address
430 W HEALTH CENTER DR, NAGS HEAD, NC 27959-8943
(252) 441-3116
(252) 441-0247
Mailing address
430 W HEALTH CENTER DR, NAGS HEAD, NC 27959-8943
(252) 441-3116
(252) 441-0247
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0372
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00965
BLUE CROSS/BLUE SHIELD
NC
05
—
3406309
—
NC
05
—
3415226
—
NC
05
—
3425226
—
NC
05
—
7802299
—
NC
Enumeration date
06/20/2006
Last updated
06/01/2011
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