NPIMap

Organization Active NPI

Tar River LTC Group, LLC

  • Adult Care Home Facility
  • Tarboro, NC
National Provider Identifier
1770529141
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
HAL033001 Issued in NC
Legal business name
TAR RIVER LTC GROUP, LLC
Practice address
3210 Western Blvd
Tarboro, NC 27886-1828
Phone
(252) 823-8546
Fax
(252) 823-3878
NPI assigned
Jun 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X HAL033001 NC Primary

Addresses

Primary practice location

3210 Western Blvd
Tarboro, NC 27886-1828

Mailing address

3210 Western Blvd
Tarboro, NC 27886-1828
Phone (252) 823-8546

Other identifiers 1

IdentifierTypeStateIssuer
7806623MedicaidNC

Other names 1

  • Open Fields Assisted Living Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1770529141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 WESTERN BLVD",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278861828",
            "telephone_number": "252-823-8546",
            "fax_number": "252-823-3878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 WESTERN BLVD",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278861828",
            "telephone_number": "252-823-8546",
            "fax_number": "252-823-3878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAR RIVER LTC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2017-04-10",
        "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": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL033001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806623",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Open Fields Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tarboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.