Provider Demographics
NPI:1285665539
Name:REDWOOD LTC GROUP, LLC
Entity Type:Organization
Organization Name:REDWOOD LTC GROUP, LLC
Other - Org Name:HARNETT WOODS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
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 1597
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-1597
Mailing Address - Country:US
Mailing Address - Phone:910-891-4600
Mailing Address - Fax:910-891-4903
Practice Address - Street 1:604 LUCAS RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6623
Practice Address - Country:US
Practice Address - Phone:910-891-4600
Practice Address - Fax:910-891-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0576314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00849OtherBC/BS OF NC
NC340611PMedicaid
NC3415478Medicaid
NC3405478Medicaid
NC3415478Medicaid