Provider Demographics
NPI:1003205337
Name:EVEREST LONG TERM CARE, LLC
Entity type:Organization
Organization Name:EVEREST LONG TERM CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:195 SPRINGBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-8105
Mailing Address - Country:US
Mailing Address - Phone:919-550-7200
Mailing Address - Fax:919-550-7299
Practice Address - Street 1:195 SPRINGBROOK AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8105
Practice Address - Country:US
Practice Address - Phone:919-550-7200
Practice Address - Fax:919-550-7299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCIPLE LONG TERM CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-09
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC345569Medicare PIN