Provider Demographics
NPI:1982640785
Name:SPRUCE LTC GROUP, LLC
Entity Type:Organization
Organization Name:SPRUCE LTC GROUP, LLC
Other - Org Name:PINE RIDGE HEALTHCARE 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 1:706 PINEYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2753
Mailing Address - Country:US
Mailing Address - Phone:336-475-9116
Mailing Address - Fax:336-475-9120
Practice Address - Street 1:706 PINEYWOOD RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2753
Practice Address - Country:US
Practice Address - Phone:336-475-9116
Practice Address - Fax:336-475-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0187314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0097UOtherBC/BS OF NC
NC3415144Medicaid
NC71-08235OtherUNITED HEALTHCARE
NC20575OtherPARTNERS INSURANCE
NC3425144Medicaid
NC3415144Medicaid
NC345144Medicare ID - Type UnspecifiedMEDICARE PROVIDER #