Healthcare Provider Details

I. General information

NPI: 1508104688
Provider Name (Legal Business Name): COMPLEX REHAB SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 9TH ST NW
HICKORY NC
28601-3523
US

IV. Provider business mailing address

431 9TH ST NW
HICKORY NC
28601-3523
US

V. Phone/Fax

Practice location:
  • Phone: 828-238-2130
  • Fax:
Mailing address:
  • Phone: 828-238-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2547
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. STACEY MULLIS
Title or Position: MEMBER
Credential: OTR
Phone: 828-238-2130