Organization
TAR RIVER LTC GROUP, LLC
Active
Other names
Roanoke Landing 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
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
314000000X
Skilled Nursing Facility
Primary
NH0419
NC
385H00000X
Respite Care
NH0419
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0085E
BC/BS OF NC
NC
05
—
3435266
—
NC
05
—
3436404
—
NC
05
—
3445266
—
NC
05
—
7806621
—
NC
Enumeration date
06/25/2006
Last updated
04/10/2017
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