Provider Demographics
NPI:1942416300
Name:LONGLEAF NEURO-MEDICAL TREATMENT CENTER
Entity Type:Organization
Organization Name:LONGLEAF NEURO-MEDICAL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - DSOHF
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-4700
Mailing Address - Street 1:4761 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4359
Mailing Address - Country:US
Mailing Address - Phone:252-399-2112
Mailing Address - Fax:252-399-2138
Practice Address - Street 1:4761 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-399-2112
Practice Address - Fax:252-399-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406177Medicaid
NC345192Medicare Oscar/Certification