Provider Demographics
NPI:1225064777
Name:BIRCH LTC GROUP, LLC
Entity Type:Organization
Organization Name:BIRCH LTC GROUP, LLC
Other - Org Name:BARBOUR COURT NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:PO BOX 2390
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-2390
Mailing Address - Country:US
Mailing Address - Phone:919-934-6017
Mailing Address - Fax:919-934-2057
Practice Address - Street 1:515 BARBOUR RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7698
Practice Address - Country:US
Practice Address - Phone:919-934-6017
Practice Address - Fax:919-934-2057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCIPLE LONG TERM CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-25
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0371314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406311Medicaid
NC00979OtherBLUE CROSS/BLUE SHIELD
NC3425237Medicaid
NC00979OtherBLUE CROSS/BLUE SHIELD
NC00979OtherBLUE CROSS/BLUE SHIELD