MEDICARE: CHRIS'S REHABILITATIVE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649675075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS'S REHABILITATIVE SERVICES

Provider Business Mailing Address
First Line	:	2303 W MEADOWVIEW RD
Second Line	:	KINSTON BUILDING SUITE 11
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 BEST RD
Second Line	:	SUITE 400-U
City	:	ATLANTA
State	:	GA
Zip	:	30337-5615
Country	:	US
Telephone Number	:	336-306-4815
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EVERETTE WITHERSPOON
Credential	:
Telephone Number	:	336-306-4815

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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