1811923931 NPI number — SNOWSHOE LTC GROUP, LLC

Table of content: (NPI 1811923931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811923931 NPI number — SNOWSHOE LTC GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNOWSHOE LTC GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811923931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
728 PINEY GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KERNERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27284-2335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-996-4038
Provider Business Mailing Address Fax Number:
336-996-0644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
728 PINEY GROVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-996-4038
Provider Business Practice Location Address Fax Number:
336-996-0644
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOICE
Authorized Official First Name:
GALE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
252-523-9094

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH0256 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15934 . This is a "PARTNERS INSURANCE #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7108231 . This is a "UNITED HEALTHCARE #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3405354 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0098C . This is a "BC/BS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3415354 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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