Ocean Trail Convalescent Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0322 Issued in NC

Legal business name

OCEAN TRAIL CONVALESCENT CENTER, INC.

Practice address

630 N Fodale Ave
Southport, NC 28461-3538

Phone

(910) 457-9581

Fax

(910) 457-9583

NPI assigned

Feb 27, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Nick Elledge

Title

Vice President

Phone

(336) 679-8852

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1891761979",
    "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, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "ELLEDGE",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "336-679-8852",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405373",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NO",
            "identifier": "0092M",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406253",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 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
• Ohm Recovery & Wellness
• Old Bridge Chiropractic, PLLC
• Lisa Carroll Osborne, MS, CCC-SLP
• Osteo Health and Balance Inc
• Elizabeth Bee Owen, PA-C

• Skilled Nursing Facility in Southport, NC
• Providers in Southport, 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 Sep 4, 2007; 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.