Provider Demographics
NPI:1942276035
Name:LOUISBURG NURSING CENTER, INC.
Entity Type:Organization
Organization Name:LOUISBURG NURSING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-8852
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0629
Mailing Address - Country:US
Mailing Address - Phone:919-496-2188
Mailing Address - Fax:919-496-3364
Practice Address - Street 1:202 SMOKETREE WAY
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2165
Practice Address - Country:US
Practice Address - Phone:919-496-2188
Practice Address - Fax:919-496-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0264314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0088GOtherBCBS PROVIDER NO
NC3406200Medicaid
NC3405358Medicaid
NC3406200Medicaid