Provider Demographics
NPI:1427142561
Name:CAROLINA REHABILITATION INC
Entity type:Organization
Organization Name:CAROLINA REHABILITATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-251-8607
Mailing Address - Street 1:305 S. FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4416
Mailing Address - Country:US
Mailing Address - Phone:910-251-8607
Mailing Address - Fax:910-251-8607
Practice Address - Street 1:305 S FRONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4416
Practice Address - Country:US
Practice Address - Phone:910-251-8607
Practice Address - Fax:910-251-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3637208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211899Medicaid
NC2500245Medicare PIN