Healthcare Provider Details

I. General information

NPI: 1154792000
Provider Name (Legal Business Name): EAST CAROLINA REHAB AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 W 5TH ST
GREENVILLE NC
27834-7813
US

IV. Provider business mailing address

201 N FRONT ST STE 805
WILMINGTON NC
28401-4055
US

V. Phone/Fax

Practice location:
  • Phone: 252-830-9100
  • Fax: 252-757-3219
Mailing address:
  • Phone: 910-332-4508
  • Fax: 910-332-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0505
License Number StateNC

VIII. Authorized Official

Name: HUGH B CAMPBELL III
Title or Position: MEMBER
Credential:
Phone: 910-332-4508