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NPI Code Detail

MEDICARE: TAR RIVER LTC GROUP, LLC

MEDICARE: TAR RIVER LTC GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH0345NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40089LOTHERNCBC/BS OF NC

General Provider Information

NPI Number : 1750317897
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAR RIVER LTC GROUP, LLC
Provider Business Mailing Address
First Line : PO BOX 398
Second Line :
City : WASHINGTON
State : NC
Zip : 27889-0398
Country : US
Telephone Number : 252-975-1636
Fax Number : 252-975-5960
Provider Business Practice Location Address
First Line : 250 LOVERS LN
Second Line :
City : WASHINGTON
State : NC
Zip : 27889-3436
Country : US
Telephone Number : 252-975-1636
Fax Number : 252-975-5960
Authorized Official
Title or Position : PRESIDENT
Name : MS. KAREN G MCDANIEL
Credential :
Telephone Number : 252-523-9094
Provider Enumeration Date : 06/23/2006
Last Update Date : 07/14/2021

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Directions to “TAR RIVER LTC GROUP, LLC ” Practice Location

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