Organization
BIRCH LTC GROUP, LLC
Active
Other names
LaGrange Gardens Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN G MCDANIEL (PRESIDENT)
(252) 523-9094
Entity
Organization
Contact information
Practice address
167 FUSSELL RD, LA GRANGE, NC 28551-7745
(252) 566-4112
(252) 566-2267
Mailing address
PO BOX 428, LA GRANGE, NC 28551-0428
(252) 566-4112
(252) 566-2267
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
HAL096001
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801106
—
NC
05
—
7806624
—
NC
01
—
W1265264509
BC/BS OF NC
NC
Enumeration date
06/23/2006
Last updated
04/07/2017
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