Healthcare Provider Details

I. General information

NPI: 1144370248
Provider Name (Legal Business Name): LONGLEAF NEURO-MEDICAL TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 WARD BLVD
WILSON NC
27893
US

IV. Provider business mailing address

4761 WARD BLVD
WILSON NC
27893-4359
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-2112
  • Fax: 252-399-2138
Mailing address:
  • Phone: 252-399-2112
  • Fax: 252-399-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier3405192
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MS. KAREN BURKES
Title or Position: DIVISION DIRECTOR
Credential:
Phone: 919-855-4700