Provider Demographics
NPI:1720306020
Name:REBUILDERS OF LIFE
Entity type:Organization
Organization Name:REBUILDERS OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-205-7779
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-1512
Mailing Address - Country:US
Mailing Address - Phone:252-205-7779
Mailing Address - Fax:
Practice Address - Street 1:2233 BELLAMY CIR
Practice Address - Street 2:124
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7274
Practice Address - Country:US
Practice Address - Phone:252-205-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency