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OCEAN TRAIL CONVALESCENT CENTER
NPI 1699961540
Custodial Care Facility - Adult Care Home in Southport, NC

Active since September 24, 2007
630 N FODALE AVE, SOUTHPORT, NC 28461(910) 457-9581(910) 457-9583 Get Directions Write a Review

NPPES record last updated: June 23, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ocean Trail Convalescent Center NPPES

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

OCEAN TRAIL CONVALESCENT CENTER (NPI 1699961540) is a healthcare organization registered as an adult care home in Southport, North Carolina and active in the NPI registry since September 2007. The organization lists Nick W Elledge, Vice President, as its authorized official.

NPPES Registry Identity

NPI1699961540
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameOCEAN TRAIL CONVALESCENT CENTER
Location Address630 N FODALE AVESouthport, NC 28461-3538
Mailing AddressPo Box 10249Southport, NC 28461-0249 · (910) 457-9581 · Fax (910) 457-9583
Phone(910) 457-9581
Fax(910) 457-9583
Organization SubpartNo
Authorized OfficialNick W ElledgeVice President · (336) 679-8852
Enumeration DateSeptember 24, 2007
Last NPPES UpdateJune 23, 2008
✔ NPI 1699961540 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 · NH0322
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.
630 N FODALE AVE, Southport, NC 28461
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Other Identifiers 1

Medicaid7801188NC

Other Providers at the Same Location NPPES 16

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

MRS. JUANITA A ADAMS
Speech-Language Pathologist
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-9581
CHRISTINE LOUISE SPARKS O.T.
Occupational Therapist
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-0830
GINNY HOPKINS COTA/L
Occupational Therapy Assistant
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-0830
MS. ANITA FAYE MCKINNEY COTA/L
Occupational Therapist
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-0830
LAUREN DAVIS BRADY
Speech-Language Pathologist
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-9581
MRS. VICTORIA WESSELL OTR/L
Occupational Therapist
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-4686
MR. CHRISTOPHER MICHAEL DILLARD LPTA
Physical Therapy Assistant
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-9581
MRS. DEBORA PYNE LIPSEN P.T.
Physical Therapist
630 N FODALE AVE
SOUTHPORT, NC 28461
Brunswick County (910) 457-9581

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 Ocean Trail Convalescent Center's NPI number?

The NPI number for Ocean Trail Convalescent Center is 1699961540. It was assigned to this organization in the NPPES registry on September 24, 2007.

Where is Ocean Trail Convalescent Center located?

Ocean Trail Convalescent Center is located at 630 N Fodale Ave, Southport, NC 28461. The listed phone number is (910) 457-9581.

What is Ocean Trail Convalescent Center's specialty?

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

When was this NPI record last updated?

The NPPES record for Ocean Trail Convalescent Center was last updated on June 23, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.