Healthcare Provider Details

I. General information

NPI: 1689628141
Provider Name (Legal Business Name): SHORELAND HEALTHCARE & RETIREMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FLOWERS PRIDGEN DR
WHITEVILLE NC
28472
US

IV. Provider business mailing address

2334 SOUTH 41ST ST
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-4300
  • Fax: 910-642-4405
Mailing address:
  • Phone: 910-332-1777
  • Fax: 910-815-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0510
License Number StateNC

VIII. Authorized Official

Name: MR. JOE CALCUTT
Title or Position: CFO
Credential:
Phone: 910-642-0224