Healthcare Provider Details

I. General information

NPI: 1760957906
Provider Name (Legal Business Name): THE NICU & BEYOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 GARDNER LAKE DR
WILLOW SPRING NC
27592-7435
US

IV. Provider business mailing address

245 GARDNER LAKE DR
WILLOW SPRING NC
27592-7435
US

V. Phone/Fax

Practice location:
  • Phone: 919-817-7273
  • Fax:
Mailing address:
  • Phone: 919-817-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD S ELMORE
Title or Position: CEO
Credential:
Phone: 919-817-7273