Provider Demographics
NPI:1316921190
Name:CENTURY CARE OF LAURINBURG INC
Entity type:Organization
Organization Name:CENTURY CARE OF LAURINBURG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-459-4716
Mailing Address - Street 1:620 JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352
Mailing Address - Country:US
Mailing Address - Phone:910-361-4000
Mailing Address - Fax:910-361-4050
Practice Address - Street 1:8900 HASTY RD
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-0706
Practice Address - Country:US
Practice Address - Phone:910-276-8400
Practice Address - Fax:910-276-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0340314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405383Medicaid
NC3406269Medicaid
NCBLUE CROSS BLUE SHIEOtherBLUE CROSS BLUE SHIELD
NCBLUE CROSS BLUE SHIEOtherBLUE CROSS BLUE SHIELD
345383Medicare Oscar/Certification