1649360686 NPI number — CAWH REHABILITATION SERVICES, LLC.

Table of content: (NPI 1649360686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649360686 NPI number — CAWH REHABILITATION SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAWH REHABILITATION SERVICES, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAWH PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649360686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10116 OLD LIBERTY RD
Provider Second Line Business Mailing Address:
PO BOX 486
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27298-8072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-622-9641
Provider Business Mailing Address Fax Number:
336-622-9713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10116 OLD LIBERTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27298-8072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-622-9641
Provider Business Practice Location Address Fax Number:
336-622-9713
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
336-622-9641

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01954 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CG1301 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DF0075 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023023678 . This is a "NPI VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007729125 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 193617 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 193615 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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