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General NPI Number Information
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NPI Number | 1245763853
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Entity Type | Organization
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Legal Business Name | PROVIDENCE REHABILITATION AND HOSPICE SERVICES
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 2515 RODGERS SCHOOL RD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-8246
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Country | US
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Telephone | 800-279-1455
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Fax |
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Provider Business Mailing Address
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Address Line | 4915 ARENDELL ST SUITE J-#323
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City | MOREHEAD CITY
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State | NC
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Zip | 28557-2659
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SIMONE GARDNER
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Credential |
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Telephone | 252-217-8487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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