NPIMap

Organization Active NPI

Tar River LTC Group, LLC

  • Skilled Nursing Facility
  • Edenton, NC
National Provider Identifier
1083659692
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0369 Issued in NC
Legal business name
TAR RIVER LTC GROUP, LLC
Practice address
1341 Paradise Rd
Edenton, NC 27932-8503
Phone
(252) 482-7481
Fax
(252) 482-7674
NPI assigned
Jun 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Karen G McDaniel
Title
President
Phone
(252) 523-9094

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NH0369 NC
Skilled Nursing Facility 314000000X NH0369 NC Primary

Addresses

Primary practice location

1341 Paradise Rd
Edenton, NC 27932-8503

Mailing address

PO Box 566
Edenton, NC 27932-0566
Phone (252) 482-7481

Other identifiers 3

IdentifierTypeStateIssuer
7802461MedicaidNC
00809OtherNCBC/BS OF NC
3425164MedicaidNC

Other names 1

  • Chowan River Nursing and Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110413000779 NC Part A Provider - Skilled Nursing Facility 9739360785 Practice locations: Edenton, NC

Skilled nursing facility certification: CCN 345164

Legal name
TAR RIVER LTC GROUP, LLC
Doing business as
CHOWAN RIVER NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1977
Last certification
Apr 2, 2025
Beds
130
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Principle LTC
Organization structure
LLCProprietary
Incorporated
Aug 20, 2010 in NC
Enrollment address
1341 Paradise Road
Edenton, NC 27932-8503
Nursing home name
CHOWAN RIVER NURSING AND REHABILITATION CENTER
Affiliated entity
PRINCIPLE LONG TERM CARE

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Chowan River Nursing and Rehabilitation CenterCCN 345164
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
13057.3 residents per day on average
Chain
Principle Long Term Care40 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0931482Tar River LTC Group, LLC1341 Paradise Road, Edenton, NC 27932Certificate of waiverJul 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ability Network5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Raymond Gregg Hill Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2011 18.47%
Adp of the SNF Jan 1, 2011
Robert O'Neil Hill Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2011 20.6%
Adp of the SNF Jan 1, 2011
Stephen Britt Hill Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2011 20.02%
Adp of the SNF Jan 1, 2011
Gale R Boice Individual Corporate OfficerCfo Mar 5, 2018
Dianne Johnson Individual Corporate OfficerTreasurer Jan 1, 2011
Principle Long Term Care, Inc. Organization, Kinston, NC Management services company, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2011 50%
Operational/Managerial Control Jan 1, 2011
Adp of the SNF Apr 9, 2025
Jeffrey Francis Severa Individual Managing Control - Governing Body Jan 1, 2025
Adp of the SNF May 16, 2025
Principle It Services, Inc. Organization, Kinston, NC Management services company 5% Or Greater Direct Ownership Interest Jan 1, 2011 50%
Meredith Turner Individual Operational/Managerial Control Mar 5, 2025
Adp of the SNF May 16, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 43

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 43

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1083659692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 566",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279320566",
            "telephone_number": "252-482-7481",
            "fax_number": "252-482-7674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 PARADISE RD",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279328503",
            "telephone_number": "252-482-7481",
            "fax_number": "252-482-7674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAR RIVER LTC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-523-9094",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NC",
            "license": "NH0369",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802461",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF NC",
            "identifier": "00809",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3425164",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Chowan River Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chowan River Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edenton, NC

Sources for this page

Verify at the official NPI Registry.