Healthcare Provider Details

I. General information

NPI: 1023177631
Provider Name (Legal Business Name): HENDERSON/VANCE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 RUIN CREEK RD
HENDERSON NC
27536-2927
US

IV. Provider business mailing address

566 RUIN CREEK RD
HENDERSON NC
27536-2927
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-4143
  • Fax:
Mailing address:
  • Phone: 252-438-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberH0267
License Number StateNC

VIII. Authorized Official

Name: JIM E CHATMAN
Title or Position: VP FINANCE CFO
Credential:
Phone: 252-436-1101