MEDICARE: REDWOOD LTC GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NH0436	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0083A	OTHER	NC	BC/BS OF NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396771515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDWOOD LTC GROUP, LLC

Provider Business Mailing Address
First Line	:	3015 ENTERPRISE DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2116
Country	:	US
Telephone Number	:	910-791-3451
Fax Number	:	910-791-4845

Provider Business Practice Location Address
First Line	:	3015 ENTERPRISE DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2116
Country	:	US
Telephone Number	:	910-791-3451
Fax Number	:	910-791-4845

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KAREN G MCDANIEL
Credential	:
Telephone Number	:	252-523-9094

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/09/2021

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Directions to “REDWOOD LTC GROUP, LLC ” Practice Location

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