Organization
TAR RIVER LTC GROUP, LLC
Active
Other names
River Trace 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
250 LOVERS LN, WASHINGTON, NC 27889-3436
(252) 975-1636
(252) 975-5960
Mailing address
PO BOX 398, WASHINGTON, NC 27889-0398
(252) 975-1636
(252) 975-5960
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0345
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0089L
BC/BS OF NC
NC
05
—
3415215
—
NC
05
—
3425215
—
NC
01
—
7801167
MEDICAID ADULT CARE #
NC
Enumeration date
06/23/2006
Last updated
07/14/2021
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