Birch LTC Group, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0379 Issued in NC

Legal business name

BIRCH LTC GROUP, LLC

Doing business as

Willow Creek Nursing and Rehabilitation Center

Practice address

2401 Wayne Memorial Dr
Goldsboro, NC 27534-1727

Phone

(919) 736-2121

Fax

(919) 736-2133

NPI assigned

Jun 21, 2006

Last updated

Jul 9, 2021By 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

Ms. Karen G McDaniel

Title

President

Phone

(252) 523-9094

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Willow Creek Nursing and Rehabilitation Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508802497. Details of each certification follow.

• CCN 345113 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 345113

Legal name

BIRCH LTC GROUP, LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jun 1, 1974

Last certification

Dec 6, 2024

Beds

200

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Principle LTC

Organization structure

LLCProprietary

Incorporated

Aug 10, 2010 in NC

Enrollment address

2401 Wayne Memorial Drive
Goldsboro, NC 27534-1727

Nursing home name

WILLOW CREEK NURSING AND REHABILITATION CENTER

Affiliated entity

PRINCIPLE LONG TERM CARE

Other NPIs with the same Medicare PAC ID 1

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

• Birch LTC Group, LLC

  dba Barbour Court Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Smithfield, NC
  • NPI 1225064777

  7113102336

  Same PAC ID

Listed as

Willow Creek Nursing and Rehabilitation CenterCCN 345113 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jun 1, 1974

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

200165.2 residents per day on average

Chain

Principle Long Term Care40 facilities in the chain

Penalties (3 years)

3Fines totaling $15,358

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Tax ID family

Ability Network3 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.

• Birch LTC Group, LLC

  dba Barbour Court Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Smithfield, NC
  • NPI 1225064777
  NPD tax ID
• Birch LTC Group, LLC

  dba LaGrange Gardens Assisted Living

  • Adult Care Home Facility
  • La Grange, NC
  • NPI 1265468441
  NPD tax ID

All disclosed owners & managing parties 10

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

Owners & managing parties with NPI records 1

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

• Ramesh Krishnaraj, MD

  • Internal Medicine Physician
  • Morganton, NC
  • NPI 1003869819

  Adp of the SNF, Managing Control - Governing Body

  CMS ownership

Facilities with the same owner 43

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

• Birch LTC Group, LLC

  dba Barbour Court Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Smithfield, NC
  • NPI 1225064777

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Continuum II Home Care & Hospice, Inc.

  dba Continuum II Home Care & Hospice of Pender County

  • Community Based Hospice Care Agency
  • Hampstead, NC
  • NPI 1457648909

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Continuum II Home Care & Hospice, Inc.

  dba Continuum Home Care & Hospice of Lenoir

  • Community Based Hospice Care Agency
  • Kinston, NC
  • NPI 1619074937

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Eagle Peak LTC Group, LLC

  dba Westwood Hills Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Wilkesboro, NC
  • NPI 1184650541

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Eagle Peak LTC Group, LLC

  dba Franklin Oaks Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Louisburg, NC
  • NPI 1376570275

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Eagle Peak LTC Group, LLC

  dba Kerr Lake Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Henderson, NC
  • NPI 1972547321

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Everest Long Term Care, LLC

  dba Springbrook Nursing and Rehabilitation

  • Skilled Nursing Facility
  • Clayton, NC
  • NPI 1003205337

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Everest Long Term Care, LLC

  dba Tower Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Raleigh, NC
  • NPI 1356387153

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Everest Long Term Care, LLC

  dba LAKE PARK Nursing & Rehabilitation Center

  • Skilled Nursing Facility
  • Indian Trail, NC
  • NPI 1548206907

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Granite Falls LTC, LLC

  dba Jacob's Creek Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Madison, NC
  • NPI 1255367447

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Granite Falls LTC, LLC

  dba Graham Healthcare and Rehabilitation Center

  • Skilled Nursing Facility
  • Robbinsville, NC
  • NPI 1366487464

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership
• Granite Falls LTC, LLC

  dba Macon Valley Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Franklin, NC
  • NPI 1457397952

  Principle It Services, Inc., Principle Long Term Care, Inc.

  CMS ownership

Affiliated clinicians 3

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

• Ramesh Krishnaraj, MD

  • Internal Medicine Physician
  • Morganton, NC
  • NPI 1003869819

  Nursing home

  Care Compare affiliation
• Raymond Edward Schmoke, M.D.

  • Internal Medicine Physician
  • Southport, NC
  • NPI 1427160068

  Nursing home

  Care Compare affiliation
• Yuthapong Sukkasem, MD

  • Family Medicine Physician
  • Salisbury, NC
  • NPI 1730162777

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1508802497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11419",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275321419",
            "telephone_number": "919-736-2121",
            "fax_number": "919-736-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341727",
            "telephone_number": "919-736-2121",
            "fax_number": "919-736-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH LTC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3425113",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF NC",
            "identifier": "00898",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415113",
            "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": "Willow Creek Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Creek Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Goldsboro, NC
• Providers in Goldsboro, 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 Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.