Provider Demographics
NPI:1225248776
Name:LUMBER RIVER HEALTHCARE CENTER
Entity Type:Organization
Organization Name:LUMBER RIVER HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-844-8150
Mailing Address - Street 1:22401 ANDREW JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-6721
Mailing Address - Country:US
Mailing Address - Phone:910-844-8150
Mailing Address - Fax:910-844-8149
Practice Address - Street 1:22401 ANDREW JACKSON HWY
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-6721
Practice Address - Country:US
Practice Address - Phone:910-844-8150
Practice Address - Fax:910-844-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC86727261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131XMMedicaid