Provider Demographics
NPI:1952446510
Name:BRUNSWICK COVE LIVING CENTER, LLC
Entity Type:Organization
Organization Name:BRUNSWICK COVE LIVING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:919-656-6735
Mailing Address - Street 1:1478 RIVER RD SE
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-5821
Mailing Address - Country:US
Mailing Address - Phone:910-371-9894
Mailing Address - Fax:910-371-9609
Practice Address - Street 1:1478 RIVER RD SE
Practice Address - Street 2:
Practice Address - City:WINNABOW
Practice Address - State:NC
Practice Address - Zip Code:28479-5821
Practice Address - Country:US
Practice Address - Phone:910-371-9894
Practice Address - Fax:910-371-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0478314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC345318Medicare PIN