MEDICARE: PREMIER LIVING AND HEALTHCARE CENTER 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

General Provider Information

NPI Number	:	1750246591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER LIVING AND HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	106 CAMERON ST
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-1900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 CAMERON ST
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-1900
Country	:	US
Telephone Number	:	910-646-3132
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SAMUEL GOLDSMITH
Credential	:
Telephone Number	:	732-619-3822

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	02/03/2026

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