Healthcare Provider Details

I. General information

NPI: 1144405804
Provider Name (Legal Business Name): SNOWSHOE LTC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 08/12/2022
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W MEADOWVIEW RD
GREENSBORO NC
27406-3610
US

IV. Provider business mailing address

308 W MEADOWVIEW RD
GREENSBORO NC
27406-3610
US

V. Phone/Fax

Practice location:
  • Phone: 336-230-0534
  • Fax: 336-230-1664
Mailing address:
  • Phone: 336-230-0534
  • Fax: 336-230-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberNH0552
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH0552
License Number StateNC

VIII. Authorized Official

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