Organization
EVEREST LONG TERM CARE, LLC
Active
Other names
LAKE PARK Nursing & 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
3315 FAITH CHURCH RD, INDIAN TRAIL, NC 28079-9300
(704) 882-3420
(704) 882-5197
Mailing address
PO BOX 2518, INDIAN TRAIL, NC 28079-2518
(704) 882-3420
(704) 882-5197
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0592
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00867
BC/BS OF NC
NC
05
—
3405502
—
NC
05
—
340613B
—
NC
05
—
3415502
—
NC
Enumeration date
06/22/2006
Last updated
07/14/2021
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