1962505313 NPI number — MARGATE HEALTH AND REHAB CENTER LLC

Table of content: (NPI 1962505313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962505313 NPI number — MARGATE HEALTH AND REHAB CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGATE HEALTH AND 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:
6
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:
1962505313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 WAUGH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28640-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-246-5581
Provider Business Mailing Address Fax Number:
336-246-5997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 WAUGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28640-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-246-5581
Provider Business Practice Location Address Fax Number:
336-246-5997
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
HARTWELL
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
252-492-2994

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: NH0459 , 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: 3435296 . This is a "MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3436466 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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