Provider Demographics
NPI:1376510784
Name:TRC OF SALISBURY, INC.
Entity Type:Organization
Organization Name:TRC OF SALISBURY, INC.
Other - Org Name:MAGNOLIA ESTATES SKILLED CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-8852
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NC
Mailing Address - Zip Code:28159-0005
Mailing Address - Country:US
Mailing Address - Phone:704-633-3892
Mailing Address - Fax:704-637-2784
Practice Address - Street 1:1404 S SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-1921
Practice Address - Country:US
Practice Address - Phone:704-633-3892
Practice Address - Fax:704-637-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0442314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406433Medicaid
NC0096GOtherBCBS PROVIDER NO
NC3405288Medicaid
NC3405288Medicaid