Ocean Trail Convalescent Center

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

NH0322 Issued in NC

Legal business name

OCEAN TRAIL CONVALESCENT CENTER

Practice address

630 N Fodale Ave
Southport, NC 28461-3538

Phone

(910) 457-9581

Fax

(910) 457-9583

NPI assigned

Sep 24, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Nick W Elledge

Title

Vice President

Phone

(336) 679-8852

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1699961540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10249",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284610249",
            "telephone_number": "910-457-9581",
            "fax_number": "910-457-9583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N FODALE AVE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284613538",
            "telephone_number": "910-457-9581",
            "fax_number": "910-457-9583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEAN TRAIL CONVALESCENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "ELLEDGE",
        "authorized_official_first_name": "NICK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "336-679-8852",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "NH0322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801188",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Novant Medical Group, Inc. (James B. Adams, MD Internal Medicine)
• Edgar E Null, FNP-C
• O.T. Center Inc.
• John Cameron O'Brien Jr., D.C.
• Oak Island Pediatrics, P.a.
• Ocean Trail Convalescent Center, Inc.
• Ohm Recovery & Wellness
• Old Bridge Chiropractic, PLLC
• Lisa Carroll Osborne, MS, CCC-SLP
• Osteo Health and Balance Inc

• Adult Care Home Facility in Southport, NC
• Providers in Southport, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.