1. Home
  2. Directory
  3. North Carolina
  4. Louisburg
  5. Custodial Care Facility
  6. NPI Profile

LOUISBURG MANOR
NPI 1669449542
Custodial Care Facility - Adult Care Home in Louisburg, NC

Active since March 01, 2006CLIA 34D2195166 · Waiver
114 SMOKETREE WAY, LOUISBURG, NC 27549(919) 496-6084(919) 496-5458 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Louisburg Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LOUISBURG MANOR (NPI 1669449542) is a healthcare organization registered as an adult care home in Louisburg, North Carolina and active in the NPI registry since March 2006. The organization holds a CLIA Waiver certificate valid through October 6, 2026 and lists Nick Elledge, Vice President, as its authorized official.

NPPES Registry Identity

NPI1669449542
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameTRC OF LOUISBURG, INC.
Location Address114 SMOKETREE WAYLouisburg, NC 27549-2117
Mailing AddressPo Box 589Louisburg, NC 27549-0589 · (919) 496-6084 · Fax (919) 496-5458
Phone(919) 496-6084
Fax(919) 496-5458
Organization SubpartNo
Authorized OfficialNick ElledgeVice President · (336) 679-8852
Enumeration DateMarch 1, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1669449542 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
License✔ Licensed in NC · HAL-035-003
Definition
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.
114 SMOKETREE WAY, Louisburg, NC 27549
Open in Google Maps ↗

Other Names 1

Doing Business AsLouisburg Manor

Other Identifiers 1

Medicaid7801294NC

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2195166

Louisburg Manor · Louisburg, NC
Active · expires Oct 6, 2026
CLIA Number34D2195166
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 7, 2024
Certificate Expiration DateOctober 6, 2026
Laboratory DirectorShannon D. Evans
Laboratory Phone(919) 496-6084
Laboratory LocationLouisburg Manor114 Smoketree Way, Louisburg, NC 27549
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TODD RANDALL BAKER PTA
Physical Therapy Assistant
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (919) 496-6084
AMANDA GAMEL COTA/L
Occupational Therapy Assistant
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (208) 608-8038
MR. JOSHUA GARRISON HICKS LPTA
Physical Therapy Assistant
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (919) 496-6084
RACHEL SEAGROVES
Physical Therapy Assistant
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (919) 218-6234
LIBERTY HEALTHCARE GROUP, LLC
Assisted Living Facility
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (919) 496-6084
ASHLEY GORDON OTR/L
Occupational Therapist
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (919) 496-6500
KATHRYN ALLEN
Occupational Therapist
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (919) 496-6084
ANGELA BELINDA WILLIAMS PTA
Physical Therapy Assistant
114 SMOKETREE WAY
LOUISBURG, NC 27549
Franklin County (919) 496-6084

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Trc Of Louisburg, Inc.'s NPI number?

The NPI number for Trc Of Louisburg, Inc. is 1669449542. It was assigned to this organization in the NPPES registry on March 1, 2006. The provider is doing business as Louisburg Manor.

Where is Trc Of Louisburg, Inc. located?

Trc Of Louisburg, Inc. is located at 114 Smoketree Way, Louisburg, NC 27549. The listed phone number is (919) 496-6084.

What is Trc Of Louisburg, Inc.'s specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Does Trc Of Louisburg, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2195166) is associated with this NPI, valid through October 6, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Trc Of Louisburg, Inc. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.