Provider Demographics
NPI:1710312079
Name:SPRUCE LTC GROUP, LLC
Entity Type:Organization
Organization Name:SPRUCE LTC GROUP, LLC
Other - Org Name:CLEAR CREEK 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 6249
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-0249
Mailing Address - Country:US
Mailing Address - Phone:252-523-9094
Mailing Address - Fax:252-939-4101
Practice Address - Street 1:10506 CLEAR CREEK COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7078
Practice Address - Country:US
Practice Address - Phone:704-545-2377
Practice Address - Fax:252-939-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNH0635OtherNURSING HOME LICENSE
NCNH0635OtherNURSING HOME LICENSE