Provider Demographics
NPI:1407882830
Name:RIVER NEUSE GROUP, LLC
Entity Type:Organization
Organization Name:RIVER NEUSE GROUP, LLC
Other - Org Name:GRANTSBROOK NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
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 1:290 KEEL RD
Mailing Address - Street 2:
Mailing Address - City:GRANTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28529-9424
Mailing Address - Country:US
Mailing Address - Phone:252-745-5005
Mailing Address - Fax:252-745-7064
Practice Address - Street 1:290 KEEL RD
Practice Address - Street 2:
Practice Address - City:GRANTSBORO
Practice Address - State:NC
Practice Address - Zip Code:28529-9424
Practice Address - Country:US
Practice Address - Phone:252-745-5005
Practice Address - Fax:252-745-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0450314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415292Medicaid
NC3416473Medicaid
NC0098FOtherBLUE CROSS/BLUE SHIELD
NC3425292Medicaid
NC345292Medicare PIN