1114050028 NPI number — REHAB BUILDERS OF THE CAROLINAS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114050028 NPI number — REHAB BUILDERS OF THE CAROLINAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB BUILDERS OF THE CAROLINAS, PLLC
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:
1114050028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13016 EASTFIELD RD
Provider Second Line Business Mailing Address:
STE 200-336
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-6622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-274-9062
Provider Business Mailing Address Fax Number:
866-268-3797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13016 EASTFIELD RD
Provider Second Line Business Practice Location Address:
STE 200-336
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-6622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-274-9062
Provider Business Practice Location Address Fax Number:
866-268-3797
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSBORNE
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST, OWNER
Authorized Official Telephone Number:
704-728-6929

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  6343 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 6278 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7412127 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7412067 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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