Healthcare Provider Details

I. General information

NPI: 1861441719
Provider Name (Legal Business Name): CAROLINA THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 PINEVILLE MATTHEWS RD SUITE 300
CHARLOTTE NC
28226-6173
US

IV. Provider business mailing address

7215 PINEVILLE MATTHEWS RD SUITE 300
CHARLOTTE NC
28226-6173
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-5244
  • Fax: 704-544-5224
Mailing address:
  • Phone: 704-544-5244
  • Fax: 704-544-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number122951
License Number StateNC

VIII. Authorized Official

Name: MISS MARGARITA M GRISHKOFF
Title or Position: PRESIDENT
Credential:
Phone: 704-544-5244