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

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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
1 NPI 1992741391
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name TAR RIVER LTC GROUP, LLC
5 Provider Other Organization Name ROANOKE RIVER NURSING AND REHABILITATION CENTER
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 119 GATLIN ST
8 Provider Business Practice Location Address City Name WILLIAMSTON
9 Provider Business Practice Location Address State Name NC
10 Provider Business Practice Location Address Postal Code 278922560
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 2527921616
13 Provider Business Practice Location Address Fax Number 2527921908
14 Provider Enumeration Date 6/22/2006
15 Last Update Date 7/11/2012
16 Authorized Official Last Name UZZELL
17 Authorized Official First Name NORWOOD
18 Authorized Official Middle Name RANDOLPH
19 Authorized Official Title or Position PRESIDENT
20 Authorized Official Telephone Number 2525239094
21 Healthcare Provider Taxonomy Code 1 314000000X
22 Provider License Number 1 NH0270
23 Provider License Number State Code 1 NC
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Other Provider Identifier 1 3446211
26 Other Provider Identifier Type Code 1 05
27 Other Provider Identifier State 1 NC
28 Other Provider Identifier 2 0093A
29 Other Provider Identifier Type Code 2 01
30 Other Provider Identifier State 2 NC
31 Other Provider Identifier Issuer 2 BC/BS OF NC
32 Other Provider Identifier 3 3465145
33 Other Provider Identifier Type Code 3 05
34 Other Provider Identifier State 3 NC
35 Other Provider Identifier 4 345145
36 Other Provider Identifier Type Code 4 04
37 Other Provider Identifier State 4 NC
38 Other Provider Identifier Issuer 4 MEDICARE PROVIDER #
39 Other Provider Identifier 5 3455145
40 Other Provider Identifier Type Code 5 05
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: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.