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General NPI Number Information
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NPI Number | 1437320769
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Entity Type | Organization
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Legal Business Name | VENTURE REHABILITATION GROUP
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 910 BREMERTON DR
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City | GREENVILLE
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State | NC
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Zip | 27858-6548
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Country | US
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Telephone | 252-412-1564
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2417
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City | WINTERVILLE
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State | NC
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Zip | 28590-2417
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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 | OWNER
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Name | MRS. CYNTHIA FLYNT
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Credential |
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Telephone | 252-412-1564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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