Provider Demographics
NPI:1356372650
Name:RIVER NEUSE GROUP, LLC
Entity type:Organization
Organization Name:RIVER NEUSE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:128 SNOW HILL ST
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7237
Mailing Address - Country:US
Mailing Address - Phone:252-746-8223
Mailing Address - Fax:252-746-2913
Practice Address - Street 1:128 SNOW HILL ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7237
Practice Address - Country:US
Practice Address - Phone:252-746-8223
Practice Address - Fax:252-746-2913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCIPLE LONG TERM CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0582314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405490Medicaid
NC3415490Medicaid
NC0097TOtherBLUE CROSS BLUE SHIELD
NC340612MMedicaid
NC3405490Medicaid