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General NPI Number Information
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NPI Number | 1821284761
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Entity Type | Organization
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Legal Business Name | IREDELL MEMORIAL HOSP SNF ICF
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 557 BROOKDALE DRIVE
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 704-873-5661
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Fax |
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Provider Business Mailing Address
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Address Line | 557 BROOKDALE DRIVE
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 704-873-5661
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ED RUSH
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Credential |
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Telephone | 704-873-5661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | H0164
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License Number State | NC
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