Healthcare Provider Details

I. General information

NPI: 1609707900
Provider Name (Legal Business Name): WILMINGTON REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4724 CASTLE HAYNE RD
CASTLE HAYNE NC
28429-6403
US

IV. Provider business mailing address

1000 PARK CENTRE BLVD STE 134
MIAMI FL
33169-5373
US

V. Phone/Fax

Practice location:
  • Phone: 305-651-3261
  • Fax:
Mailing address:
  • Phone: 305-651-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JACOB
Title or Position: CEO
Credential:
Phone: 646-596-4370