1083963227 NPI number — RALEIGH REGIONAL REHAB CENTER LLC

Table of content: (NPI 1083963227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083963227 NPI number — RALEIGH REGIONAL REHAB CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALEIGH REGIONAL REHAB CENTER 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:
Provider Other Organization Name Type Code:
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:
1083963227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 10TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAFETY HARBOR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34695-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-797-5200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3830 BLUE RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27612-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-781-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FISK
Authorized Official First Name:
TRINA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
727-797-5200

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH0428 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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