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Organization
TAR RIVER LTC GROUP, LLC
Active
Organization
TAR RIVER LTC GROUP, LLC
Active
Other names
River Trace 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
250 LOVERS LN, WASHINGTON, NC 27889-3436
(252) 975-1636
(252) 975-5960
Mailing address
PO BOX 398, WASHINGTON, NC 27889-0398
(252) 975-1636
(252) 975-5960
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0345
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0089L
BC/BS OF NC
NC
05
—
3415215
—
NC
05
—
3425215
—
NC
01
—
7801167
MEDICAID ADULT CARE #
NC
Enumeration date
06/23/2006
Last updated
07/14/2021
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