MEDICARE: MECKLENBURG HEALTH AND REHABILITATION, LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1790317840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MECKLENBURG HEALTH AND REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	229 AIRPORT RD STE 7-104
Second Line	:
City	:	ARDEN
State	:	NC
Zip	:	28704-6402
Country	:	US
Telephone Number	:	919-608-9123
Fax Number	:	919-882-9771

Provider Business Practice Location Address
First Line	:	2415 SANDY PORTER RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-3695
Country	:	US
Telephone Number	:	704-583-0430
Fax Number	:	704-583-0433

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CHRISTOPHER JOHN SPRENGER
Credential	:
Telephone Number	:	919-608-9123

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	04/26/2022

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