Organization
TAR RIVER LTC GROUP, LLC
Active
Other names
Roanoke Landing Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
NORWOOD RANDOLPH UZZELL (PRESIDENT)
(252) 523-9094
Entity
Organization
Contact information
Practice address
1084 US HIGHWAY 64 E, PLYMOUTH, NC 27962-9215
(252) 793-2100
(252) 793-1243
Mailing address
1084 US HIGHWAY 64 E, PLYMOUTH, NC 27962-9215
(252) 793-2100
(252) 793-1243
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH0419
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805286
—
NC
05
—
7806621
—
NC
Enumeration date
01/08/2008
Last updated
05/09/2012
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