Provider Demographics
NPI:1063458958
Name:RIVER NEUSE GROUP, LLC
Entity Type:Organization
Organization Name:RIVER NEUSE GROUP, LLC
Other - Org Name:GREENDALE FOREST NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-0677
Mailing Address - Country:US
Mailing Address - Phone:252-747-8126
Mailing Address - Fax:252-747-7491
Practice Address - Street 1:1304 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-2014
Practice Address - Country:US
Practice Address - Phone:252-747-8126
Practice Address - Fax:252-747-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0373314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415366Medicaid
NC00901OtherBC/BS OF NC
NC3405366Medicaid
NC3405366Medicaid
NC561370182OtherAETNA
NC3415366Medicaid