TAR RIVER LTC GROUP, LLC (ROANOKE RIVER NURSING AND REHABILITATION CENTER) - NPI NUMBER 1992741391

Summary

Provider Name: TAR RIVER LTC GROUP, LLC (ROANOKE RIVER NURSING AND REHABILITATION CENTER)

NPI Number: 1992741391

Clasification: Skilled Nursing Facility (314000000X)

Address:
119 GATLIN ST
WILLIAMSTON, NC
ZIP 27892

Phone Number: (252) 792-1616



Detailed Information

TAR RIVER LTC GROUP, LLC is a skilled nursing facility in Williamston, NC. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. The assigned NPI number for this provider is 1992741391 and is registered as an organization entity type.
The provider Is Doing Business As Roanoke River Nursing And Rehabilitation Center.

The provider's business address is:

119 GATLIN ST
WILLIAMSTON, NC
ZIP 27892-560
Phone: (252) 792-1616
Fax: (252) 792-1908

The provider's authorized official is Norwood Randolph Uzzell .
The authorized official title is President and has the following contact phone number (252) 523-9094.

The enumeration date for this NPI number is 6/22/2006 and was last updated on 7/11/2012.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 314000000X Skilled Nursing Facility NH0270 NC Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 3446211 MEDICAID NC
2 0093A OTHER NC BC/BS OF NC
3 3465145 MEDICAID NC
4 345145 MEDICARE ID-TYPE UNSPECIFIED NC MEDICARE PROVIDER #
5 3455145 MEDICAID NC

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1992741391 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name TAR RIVER LTC GROUP, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name ROANOKE RIVER NURSING AND REHABILITATION CENTER Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 119 GATLIN ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name WILLIAMSTON The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name NC The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 278922560 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 2527921616 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 2527921908 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 6/22/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 7/11/2012 The date that a record was last updated or changed.
16 Authorized Official Last Name UZZELL The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name NORWOOD The first name of the authorized official.
18 Authorized Official Middle Name RANDOLPH The middle name of the authorized official.
19 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
20 Authorized Official Telephone Number 2525239094 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 314000000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Provider License Number 1 NH0270 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
23 Provider License Number State Code 1 NC The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Other Provider Identifier 1 3446211 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier State 1 NC
28 Other Provider Identifier 2 0093A Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier Type Code 2 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier State 2 NC
31 Other Provider Identifier Issuer 2 BC/BS OF NC
32 Other Provider Identifier 3 3465145 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier State 3 NC
35 Other Provider Identifier 4 345145 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
36 Other Provider Identifier Type Code 4 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier State 4 NC
38 Other Provider Identifier Issuer 4 MEDICARE PROVIDER #
39 Other Provider Identifier 5 3455145 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
40 Other Provider Identifier Type Code 5 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
41 Other Provider Identifier State 5 NC
42 Is Organization Subpart N
43 Authorized Official Name Prefix Text MR.

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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