Healthcare Provider Details

I. General information

NPI: 1548206907
Provider Name (Legal Business Name): EVEREST LONG TERM CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 FAITH CHURCH RD
INDIAN TRAIL NC
28079-9300
US

IV. Provider business mailing address

PO BOX 2518
INDIAN TRAIL NC
28079-2518
US

V. Phone/Fax

Practice location:
  • Phone: 704-882-3420
  • Fax: 704-882-5197
Mailing address:
  • Phone: 704-882-3420
  • Fax: 704-882-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0592
License Number StateNC

VIII. Authorized Official

Name: MS. KAREN G MCDANIEL
Title or Position: PRESIDENT
Credential:
Phone: 252-523-9094