Healthcare Provider Details

I. General information

NPI: 1073580957
Provider Name (Legal Business Name): ELIZABETHTOWN NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MERCER RD
ELIZABETHTOWN NC
28337-3938
US

IV. Provider business mailing address

PO BOX 1449
ELIZABETHTOWN NC
28337-1449
US

V. Phone/Fax

Practice location:
  • Phone: 910-862-8181
  • Fax: 910-862-4860
Mailing address:
  • Phone: 910-862-8181
  • Fax: 910-862-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0328
License Number StateNC

VIII. Authorized Official

Name: MR. NICK ELLEDGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-679-8852