Healthcare Provider Details

I. General information

NPI: 1972534352
Provider Name (Legal Business Name): GALLOWAY RIDGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CRAGGAMORE
PITTSBORO NC
27312
US

IV. Provider business mailing address

3000 GALLOWAY RIDGE ROAD
PITTSBORO NC
27312-8639
US

V. Phone/Fax

Practice location:
  • Phone: 919-545-2215
  • Fax: 919-545-2696
Mailing address:
  • Phone: 919-545-2215
  • Fax: 919-545-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT P ZIMMER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-545-2604