Tar River LTC Group, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0372 Issued in NC

Legal business name

TAR RIVER LTC GROUP, LLC

Doing business as

Colony Ridge Nursing and Rehabilitation Center

Practice address

430 W Health Center Dr
Nags Head, NC 27959-8943

Phone

(252) 441-3116

Fax

(252) 441-0247

NPI assigned

Jun 20, 2006

Last updated

Jun 1, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Norwood Randolph Uzzell

Title

President

Phone

(252) 523-9094

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Colony Ridge Nursing and Rehabilitation Center Doing business as

Tax ID family

Britthaven of Outer Banks3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Outer Banks Haven, Inc.

  dba Britthaven of Wilkesboro

  • Nursing Facility/Intermediate Care Facility
  • Wilkesboro, NC
  • NPI 1093902421
  NPD tax ID
• Outer Banks Haven, Inc.

  dba Britthaven of Outer Banks

  • Nursing Facility/Intermediate Care Facility
  • Nags Head, NC
  • NPI 1902094543
  NPD tax ID

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1356386445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W HEALTH CENTER DR",
            "city": "NAGS HEAD",
            "state": "NC",
            "postal_code": "279598943",
            "telephone_number": "252-441-3116",
            "fax_number": "252-441-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W HEALTH CENTER DR",
            "city": "NAGS HEAD",
            "state": "NC",
            "postal_code": "279598943",
            "telephone_number": "252-441-3116",
            "fax_number": "252-441-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAR RIVER LTC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "UZZELL",
        "authorized_official_first_name": "NORWOOD",
        "authorized_official_middle_name": "RANDOLPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-523-9094",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "00965",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802299",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406309",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415226",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3425226",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colony Ridge Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacey Ann Starsman, CNM
• Gillian Lennox Stewart, DPT
• Holly Michele Strum
• Kerri Styn
• Karen A Supan-McPherson, M.D.
• Kellie Deanne Tatro, PA-C, RRA, RT(R)
• The Outer Banks Hospital Inc
• The Outer Banks Hospital Inc
• The Outer Banks Hospital Inc
• The Outer Banks Hospital, Inc.

• Skilled Nursing Facility in Nags Head, NC
• Providers in Nags Head, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.