Organization
PREMIER LIVING AND REHAB CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA BENTON PARNELL LNHA (ADMINISTRATOR)
(910) 646-3132
Entity
Organization
Contact information
Practice address
106 CAMERON ST, LAKE WACCAMAW, NC 28450-1900
(910) 646-3132
(910) 646-4071
Mailing address
106 CAMERON ST, LAKE WACCAMAW, NC 28450-1900
(910) 646-3132
(910) 646-4071
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
NC
314000000X
Skilled Nursing Facility
NH0246
NC
332BN1400X
Nursing Facility Supplies (DME)
5030990001
NC
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
5030990001
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3435185
—
NC
05
—
3436171
—
NC
05
—
7804320
—
NC
Enumeration date
06/30/2005
Last updated
11/02/2011
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