Healthcare Provider Details

I. General information

NPI: 1164848503
Provider Name (Legal Business Name): ZEBULON REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W GANNON AVE
ZEBULON NC
27597-2509
US

IV. Provider business mailing address

5887 GLENRIDGE DR SUITE 150
ATLANTA GA
30328-5574
US

V. Phone/Fax

Practice location:
  • Phone: 919-269-9621
  • Fax: 919-269-5703
Mailing address:
  • Phone: 404-574-2100
  • Fax: 404-574-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0317
License Number StateNC

VIII. Authorized Official

Name: MR. R. MARK CRONQUIST
Title or Position: MANAGER
Credential:
Phone: 404-574-2100