Provider Demographics
NPI:1558393835
Name:MAPLE LTC GROUP, LLC
Entity Type:Organization
Organization Name:MAPLE LTC GROUP, LLC
Other - Org Name:CAROLINA RIVERS 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:PO BOX 5021
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-1021
Mailing Address - Country:US
Mailing Address - Phone:910-455-3610
Mailing Address - Fax:910-455-3993
Practice Address - Street 1:1839 ONSLOW DR. EXT.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-455-3610
Practice Address - Fax:910-455-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0370314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00892OtherBLUE CROSS/BLUE SHIELD
NC3425072Medicaid
NC3496587Medicaid
NC3496587Medicaid
NC3415072Medicaid