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General NPI Number Information
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NPI Number | 1083659692
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Entity Type | Organization
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Legal Business Name | TAR RIVER LTC GROUP, LLC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 1341 PARADISE RD
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City | EDENTON
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State | NC
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Zip | 27932-8503
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Country | US
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Telephone | 252-482-7481
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Fax | 252-482-7674
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Provider Business Mailing Address
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Address Line | PO BOX 566
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City | EDENTON
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State | NC
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Zip | 27932-0566
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Country | US
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Telephone | 252-482-7481
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Fax | 252-482-7674
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KAREN G MCDANIEL
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Credential |
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Telephone | 252-523-9094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | NH0369
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0369
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License Number State | NC
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