Healthcare Provider Details

I. General information

NPI: 1063458958
Provider Name (Legal Business Name): RIVER NEUSE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SE 2ND ST
SNOW HILL NC
28580-2014
US

IV. Provider business mailing address

PO BOX 677
SNOW HILL NC
28580-0677
US

V. Phone/Fax

Practice location:
  • Phone: 252-747-8126
  • Fax: 252-747-7491
Mailing address:
  • Phone: 252-747-8126
  • Fax: 252-747-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0373
License Number StateNC

VIII. Authorized Official

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