Organization
CENTURY CARE OF THE CRYSTAL COAST, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT E GILLIAM (PRESIDENT)
(919) 467-8686
Entity
Organization
Contact information
Practice address
4010 BRIDGES STREET EXTENSION, MOREHEAD CITY, NC 28557-4304
(252) 726-0031
(252) 726-5831
Mailing address
4010 BRIDGES STREET EXTENSION, MOREHEAD CITY, NC 28557-4304
(252) 726-0031
(252) 726-5831
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0227
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0080Q
BLUE CROSS BLUE SHIELD
NC
05
—
3435170
—
NC
05
—
3436147
—
NC
Enumeration date
12/05/2005
Last updated
07/08/2008
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