Provider Demographics
NPI:1356387153
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
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 1:3609 BOND ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3801
Mailing Address - Country:US
Mailing Address - Phone:919-231-8113
Mailing Address - Fax:919-231-8144
Practice Address - Street 1:3609 BOND ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3801
Practice Address - Country:US
Practice Address - Phone:919-231-8113
Practice Address - Fax:919-231-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0354314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405513Medicaid
NC3415513Medicaid
NC00975OtherBC/BS OF NC
NC345513Medicare PIN
NC340613RMedicaid