Healthcare Provider Details

I. General information

NPI: 1407882830
Provider Name (Legal Business Name): RIVER NEUSE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 KEEL RD
GRANTSBORO NC
28529-9424
US

IV. Provider business mailing address

290 KEEL RD
GRANTSBORO NC
28529-9424
US

V. Phone/Fax

Practice location:
  • Phone: 252-745-5005
  • Fax: 252-745-7064
Mailing address:
  • Phone: 252-745-5005
  • Fax: 252-745-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0450
License Number StateNC

VIII. Authorized Official

Name: GALE BOICE
Title or Position: CFO
Credential:
Phone: 252-523-9094