MEDICARE: BRUNSWICK COVE LIVING 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	NH0478	NC

General Provider Information

NPI Number	:	1952446510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUNSWICK COVE LIVING CENTER, LLC

Provider Business Mailing Address
First Line	:	1478 RIVER RD SE
Second Line	:
City	:	WINNABOW
State	:	NC
Zip	:	28479-5821
Country	:	US
Telephone Number	:	910-371-9894
Fax Number	:	910-371-9609

Provider Business Practice Location Address
First Line	:	1478 RIVER RD SE
Second Line	:
City	:	WINNABOW
State	:	NC
Zip	:	28479-5821
Country	:	US
Telephone Number	:	910-371-9894
Fax Number	:	910-371-9609

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. HUGH BLAINE CAMPBELL III
Credential	:
Telephone Number	:	919-656-6735

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	10/09/2009

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