Provider Demographics
NPI:1932267028
Name:CAROLINA REHABILITATION MEDICINE, P.C.
Entity type:Organization
Organization Name:CAROLINA REHABILITATION MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREEMAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BROADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-808-4022
Mailing Address - Street 1:1027 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3573
Mailing Address - Country:US
Mailing Address - Phone:828-692-5781
Mailing Address - Fax:828-696-8606
Practice Address - Street 1:1027 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3573
Practice Address - Country:US
Practice Address - Phone:828-692-5781
Practice Address - Fax:828-696-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherFEDERAL TAX ID#
NCE97861Medicare UPIN