Healthcare Provider Details

I. General information

NPI: 1134660103
Provider Name (Legal Business Name): VILLAGE GREEN HEALTH AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PURDUE DR
FAYETTEVILLE NC
28304-3674
US

IV. Provider business mailing address

229 AIRPORT RD SUITE 7-104
ARDEN NC
28704-6402
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5000
  • Fax: 910-485-6388
Mailing address:
  • Phone: 919-608-9123
  • Fax: 919-882-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0502
License Number StateNC

VIII. Authorized Official

Name: MR. CHRISTOPHER JOHN SPRENGER
Title or Position: MANAGER
Credential:
Phone: 919-608-9123