Provider Demographics
NPI:1881762961
Name:RV NURSING HOME, LLC
Entity type:Organization
Organization Name:RV NURSING HOME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-209-6834
Mailing Address - Street 1:400 NORTH MAIN STREET
Mailing Address - Street 2:P O BOX 560
Mailing Address - City:RICH SQUARE
Mailing Address - State:NC
Mailing Address - Zip Code:27869-0560
Mailing Address - Country:US
Mailing Address - Phone:252-539-4145
Mailing Address - Fax:252-539-2479
Practice Address - Street 1:400 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICH SQUARE
Practice Address - State:NC
Practice Address - Zip Code:27869-0560
Practice Address - Country:US
Practice Address - Phone:252-539-4145
Practice Address - Fax:252-539-2479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RV NURSING HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-066-011310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility