1255425427 NPI number — CAROLINA HEALTH CARE CENTER OF BURKE LIMITED PARTNERSHIP

Table of content: (NPI 1255425427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255425427 NPI number — CAROLINA HEALTH CARE CENTER OF BURKE LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA HEALTH CARE CENTER OF BURKE LIMITED PARTNERSHIP
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:
CAROLINA REHAB CENTER OF BURKE
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:
1255425427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2917 PENN FOREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-989-3618
Provider Business Mailing Address Fax Number:
540-744-9443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3647 MILLER BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNELLYS SPRINGS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28612-7347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-397-3144
Provider Business Practice Location Address Fax Number:
828-397-2349
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CLAUDE
Authorized Official Middle Name:
NOVEL
Authorized Official Title or Position:
CFO, MFA INC. GENERAL PARTNER
Authorized Official Telephone Number:
540-776-7526

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  NH0610 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: NH0610 , 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: 3405526 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340614H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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