# BIRCH LTC GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willow Creek Nursing and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508802497
- **Authorized official:** MS. KAREN G MCDANIEL (PRESIDENT)
- **Authorized official phone:** (252) 523-9094

## Contact information

- **Practice address:** 2401 WAYNE MEMORIAL DR, GOLDSBORO, NC 27534-1727
- **Practice address phone:** (919) 736-2121
- **Practice address fax:** (919) 736-2133
- **Mailing address:** PO BOX 11419, GOLDSBORO, NC 27532-1419
- **Mailing address phone:** (919) 736-2121
- **Mailing address fax:** (919) 736-2133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0379 | NC | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 07/09/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00898 | BC/BS OF NC | NC |
| 05 | — | 3415113 | — | NC |
| 05 | — | 3425113 | — | NC |