Healthcare Provider Details

I. General information

NPI: 1730321951
Provider Name (Legal Business Name): ADVANTAGE REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 HOUSE AVE
SCOTLAND NECK NC
27874-1140
US

IV. Provider business mailing address

PO BOX 247
RICH SQUARE NC
27869-0247
US

V. Phone/Fax

Practice location:
  • Phone: 252-826-0312
  • Fax:
Mailing address:
  • Phone: 252-826-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERNEST RICHARD CHAMBERS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 919-806-9547