Healthcare Provider Details

I. General information

NPI: 1689603060
Provider Name (Legal Business Name): SPRUCE LTC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 OLD CHERAW HWY
HAMLET NC
28345
US

IV. Provider business mailing address

PO BOX 1489
HAMLET NC
28345-1489
US

V. Phone/Fax

Practice location:
  • Phone: 910-582-0021
  • Fax: 910-205-0244
Mailing address:
  • Phone: 910-582-0021
  • Fax: 910-205-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0455
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0098H
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBC/BS OF NC
# 2
Identifier3415293
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier3405293
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

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