Provider Demographics
NPI:1720166838
Name:TARBORO CARE LLC
Entity Type:Organization
Organization Name:TARBORO CARE LLC
Other - Org Name:PRODIGY TRANSITIONAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-823-2041
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:911 WESTERN BLVD
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886
Mailing Address - Country:US
Mailing Address - Phone:252-823-2041
Mailing Address - Fax:252-641-1741
Practice Address - Street 1:911 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886
Practice Address - Country:US
Practice Address - Phone:252-823-2041
Practice Address - Fax:252-641-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
NCNH0327314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405510Medicaid
NC340613NOtherICF
NC340613NOtherICF