Provider Demographics
NPI:1144405804
Name:SNOWSHOE LTC GROUP, LLC
Entity Type:Organization
Organization Name:SNOWSHOE LTC GROUP, LLC
Other - Org Name:MAPLE GROVE HEALTH 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 1:308 W MEADOWVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-3610
Mailing Address - Country:US
Mailing Address - Phone:336-230-0534
Mailing Address - Fax:336-230-1664
Practice Address - Street 1:308 W MEADOWVIEW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3610
Practice Address - Country:US
Practice Address - Phone:336-230-0534
Practice Address - Fax:336-230-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0552311ZA0620X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806638Medicaid
NC7802688Medicaid