Organization
TAR RIVER LTC GROUP, LLC
Active
Other names
Roanoke River 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
119 GATLIN ST, WILLIAMSTON, NC 27892-2560
(252) 792-1616
(252) 792-1908
Mailing address
119 GATLIN ST, WILLIAMSTON, NC 27892-2560
(252) 792-1616
(252) 792-1908
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0270
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0093A
BC/BS OF NC
NC
05
—
3455145
—
NC
05
—
3465145
—
NC
Enumeration date
06/22/2006
Last updated
04/10/2017
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