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Organization
OCEAN TRAIL CONVALESCENT CENTER, INC.
Active
Organization
OCEAN TRAIL CONVALESCENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICK ELLEDGE (VICE PRESIDENT)
(336) 679-8852
Entity
Organization
Contact information
Practice address
630 N FODALE AVE, SOUTHPORT, NC 28461-3538
(910) 457-9581
(910) 457-9583
Mailing address
PO BOX 10249, SOUTHPORT, NC 28461-0249
(910) 457-9581
(910) 457-9583
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0322
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0092M
BCBS PROVIDER NO
NC
05
—
3405373
—
NC
05
—
3406253
—
NC
Enumeration date
02/27/2006
Last updated
09/04/2007
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