Provider Demographics
NPI:1578748414
Name:RAINTREE HEALTHCARE OF TABOR CITY, LLC
Entity Type:Organization
Organization Name:RAINTREE HEALTHCARE OF TABOR CITY, LLC
Other - Org Name:WATERBROOKE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-6300
Mailing Address - Street 1:PO BOX 668611
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-8611
Mailing Address - Country:US
Mailing Address - Phone:910-653-6400
Mailing Address - Fax:803-631-3939
Practice Address - Street 1:703 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-2603
Practice Address - Country:US
Practice Address - Phone:910-653-6400
Practice Address - Fax:910-653-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL024010310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility