OCEAN TRAIL CONVALESCENT CENTER (NPI# 1699961540) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699961540 |
| Entity Type | Organization |
| Organization Name | OCEAN TRAIL CONVALESCENT CENTER |
| Practice Address |
630 N Fodale Ave Southport NC 28461-3538 |
| Mailing Address |
Po Box 10249 Southport NC 28461-0249 |
| Practice Telephone | 9104579581 |
| Practice Fax Number | 9104579583 |
| Mailing Telephone | 9104579581 |
| Mailing Fax Number | 9104579583 |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2008-06-23 |
| Authorized Official Name | MR. NICK W ELLEDGE (VICE PRESIDENT) |
| Authorized Official Telephone | 3366798852 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
NH0322 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7801188 | 05 |
| Street Address |
630 N FODALE AVE |
| City | SOUTHPORT |
| State | NC |
| Zip Code | 28461-3538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891761979 | Ocean Trail Convalescent Center, Inc. | Skilled Nursing Facility | 630 N Fodale Ave, Southport, NC 28461-3538 | 2006-02-27 |
| 1548770423 | Liberty Healthcare Group LLC | Skilled Nursing Facility | 630 N Fodale Ave, Southport, NC 28461 | 2017-10-05 |
| 1548642754 | Laura Elson | Physical Therapist | 630 N Fodale Ave, Southport, NC 28461-3538 | 2015-06-24 |
| 1952791832 | Chris G Shepherd | Physical Therapy Assistant | 630 N Fodale Ave, Southport, NC 28461-3538 | 2015-01-29 |
| 1245635317 | Ginny Hopkins | Occupational Therapy Assistant | 630 N Fodale Ave, Southport, NC 28461-3538 | 2014-10-30 |
| 1275978173 | Anita Faye Mckinney | Occupational Therapist | 630 N Fodale Ave, Southport, NC 28461-3538 | 2013-05-06 |
| 1902106065 | Douglas Erick Wood | Physical Therapy Assistant | 630 N Fodale Ave, Southport, NC 28461-3538 | 2010-10-23 |
| 1427366343 | Victoria Wessell | Occupational Therapist | 630 N Fodale Ave, Southport, NC 28461-3538 | 2010-09-14 |
| 1326367962 | Lauren Davis Brady | Speech-Language Pathologist | 630 N Fodale Ave, Southport, NC 28461-3538 | 2010-05-21 |
| 1740503812 | Harrietthall Hall Witherspoon | Occupational Therapist | 630 N Fodale Ave, 630 N Fodale Ave, Southport, NC 28461-3538 | 2010-03-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225645542 | Island Time Medical and Wellness, Pllc | Clinic/Center | 39 Dowitcher Trl, Bald Head Island, NC 28461 | 2020-09-30 |
| 1871095356 | Sunny Point Fire & Rescue | Emergency Medicine | 6280 Sunny Point Rd Bldg 44, Southport, NC 28461 | 2018-03-01 |
| 1962882035 | Kimberlee Kreuzer | Physical Therapist | 1517 N Howe St Suite 4, Southport, NC 28461 | 2015-06-04 |
| 1134449291 | Kristos Nektarios Vaughan | Family Medicine | 3009 Medical Plaza Lane, Southport, NC 28461 | 2010-06-10 |
| 1750612974 | Melissa Holden | Nurse Practitioner | 1517 N Howe St Ste 12, Southport, NC 28461 | 2010-01-28 |
| 1437315165 | North Carolina Shoulder and Elbow Surgery and Sports Medicine | Orthopaedic Surgery | 900 North Howe St, Southport, NC 28461 | 2008-08-01 |
| 1124212329 | Edward Frank Babel | Nurse Practitioner | 201 West Boiling Spring Lakes Road, New Hope Clinic, Boiling Spring Lakes, NC 28461 | 2007-08-30 |
| 1952453151 | Robert Wayne Poe | Otolaryngology | 900 N. Howe St, Southport, NC 28461 | 2007-01-17 |
| 1275640898 | Kurt Thomas Scheetz | Dentist | 1301 N Howe Street, Southport, NC 28461 | 2006-08-23 |
| 1396859872 | Brunswick Family Medicine Pa | Family Medicine | 3960 Executive Park Blvd, Unit 600, Southport, NC 28461 | 2006-08-19 |
| Find all providers in zip 28461 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578162061 | Lewis E Williams | Custodial Care Facility | 1640 Bridgedale Dr, Rocky Mount, NC 27803-1604 | 2020-10-26 |
| 1861008583 | Arbor Landing At Hampstead LLC | Custodial Care Facility | 13937 Us Highway 17, Hampstead, NC 28443-4041 | 2020-09-17 |
| 1124645544 | Charlotte Sp Senior Housing Opco, LLC | Custodial Care Facility | 6041 Piedmont Row Drive, Charlotte, NC 28208 | 2020-07-01 |
| 1740804111 | Happy Hearts Group Home | Custodial Care Facility | 6255 Burlington Rd, Gibsonville, NC 27249-8783 | 2020-06-02 |
| 1730703422 | Graham 4 Enterprises | Custodial Care Facility | 3006 W Sedgefield Dr, Greensboro, NC 27407-7313 | 2020-05-29 |
| 1477177111 | C&s Adult Care LLC, Dba Deal Care Inn | Custodial Care Facility | 1075 Deal Rd, Mooresville, NC 28115-6719 | 2020-05-28 |
| 1114554516 | Cassandra Davis | Custodial Care Facility | 131 Huntington Rd, Louisburg, NC 27549 | 2020-03-25 |
| 1356975767 | Cornerstone Community Service | Custodial Care Facility | 2220 Southgate St, Durham, NC 27703-2102 | 2020-02-24 |
| 1477184653 | Rose Vista Assisted Living, LLC | Custodial Care Facility | 2130 Rose Vista Rd, Kinston, NC 28504-8230 | 2020-01-28 |
| 1104456011 | Regina Williams | Custodial Care Facility | 511 Tansy Drive, Charlotte, NC 28214 | 2020-01-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.