Organization · NPI-2

630 Carolina Bay Opco LLC

Skilled Nursing Facility · Wilmington, NC

NPI number1275308959
StatusActive
Last updated in NPPESNov 22, 2023

Details

NPI
1275308959
Entity type
Organization (NPI-2)
Legal business name
630 Carolina Bay Opco LLC
Organization subpart
No
Enumeration date
Nov 22, 2023
Certification date
Nov 22, 2023
Last updated
Nov 22, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
314000000X Skilled Nursing Facility––Yes

Other names

  • Bradley Creek Health Center (Doing Business As)

Practice location

740 Diamond Shoals Rd
Wilmington, NC 28403-4388

Phone 910-769-7500

Mailing address

4500 Dorr St
Toledo, OH 43615-4040

Phone 419-247-2800

Authorized official

Sharon Makowsky
Authorized Official
4192472800

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