Provider Demographics
NPI:1376749200
Name:MORGANTON LONG TERM CARE, INC.
Entity Type:Organization
Organization Name:MORGANTON LONG TERM CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOODBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-433-5069
Mailing Address - Street 1:PO BOX 1261
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680
Mailing Address - Country:US
Mailing Address - Phone:828-433-5069
Mailing Address - Fax:828-438-4774
Practice Address - Street 1:151 SOUTHVIEW ST.
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655
Practice Address - Country:US
Practice Address - Phone:828-433-5049
Practice Address - Fax:828-438-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-012-007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802761Medicaid