Provider Demographics
NPI:1932178670
Name:BN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BN HEALTHCARE, LLC
Other - Org Name:TAR RIVER MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-633-0055
Mailing Address - Street 1:2578 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7812
Mailing Address - Country:US
Mailing Address - Phone:252-758-7100
Mailing Address - Fax:252-758-1485
Practice Address - Street 1:2578 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7812
Practice Address - Country:US
Practice Address - Phone:252-758-7100
Practice Address - Fax:252-758-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0446314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3416503Medicaid
NC3445181Medicaid
NC0092BOtherBCBS PROVIDER NUMBER
NC3416503Medicaid