Healthcare Provider Details

I. General information

NPI: 1659367480
Provider Name (Legal Business Name): REHABILITATION AND HEALTH CARE CENTER AT VILLAGE GREEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PURDUE DR
FAYETTEVILLE NC
28304-3674
US

IV. Provider business mailing address

1601 PURDUE DR
FAYETTEVILLE NC
28304-3674
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5000
  • Fax: 910-486-5266
Mailing address:
  • Phone: 910-486-5000
  • Fax: 910-486-5266

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. STEPHEN GENTZLER
Title or Position: CFO
Credential:
Phone: 910-483-7666