Provider Demographics
NPI:1942236161
Name:RIVER NEUSE GROUP, LLC
Entity Type:Organization
Organization Name:RIVER NEUSE GROUP, LLC
Other - Org Name:CROATAN RIDGE 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 1:210 FOXHALL RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-6790
Mailing Address - Country:US
Mailing Address - Phone:252-223-2560
Mailing Address - Fax:252-223-3370
Practice Address - Street 1:210 FOXHALL RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-6790
Practice Address - Country:US
Practice Address - Phone:252-223-2560
Practice Address - Fax:252-223-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0583314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415491Medicaid
NC0089DOtherBC/BS OF NC
NC340612HMedicaid
NC3405491Medicaid
NC340612HMedicaid