Provider Demographics
NPI:1699967547
Name:COMPLETE REHAB
Entity type:Organization
Organization Name:COMPLETE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-778-0292
Mailing Address - Street 1:6000 MEADOW BROOK MALL
Mailing Address - Street 2:SUITE 22
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8775
Mailing Address - Country:US
Mailing Address - Phone:336-778-0292
Mailing Address - Fax:336-778-0242
Practice Address - Street 1:6000 MEADOW BROOK MALL
Practice Address - Street 2:SUITE 22
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8775
Practice Address - Country:US
Practice Address - Phone:336-778-0292
Practice Address - Fax:336-778-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135VAOtherBCBSNC
NC64-01026OtherSECURE HORIZONS
691687OtherACN GROUP
NC10378967OtherNC VOCATIONAL REHAB
NC0517000OtherUNITED HEALTH CARE
NC7301751Medicaid
NC805848OtherPARTNERS
NCBA1238OtherMEDCOST
NC2338417Medicare PIN