Provider Demographics
NPI:1003367160
Name:FOUNDATION HEALTH SYSTEMS CORP
Entity Type:Organization
Organization Name:FOUNDATION HEALTH SYSTEMS CORP
Other - Org Name:NOVANT HEALTH REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REHAB MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIELEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-316-1550
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:336-277-7226
Mailing Address - Fax:336-277-9795
Practice Address - Street 1:2085 FRONTIS PLAZA BLVD
Practice Address - Street 2:ATTN: FACILITY CREDENTIALING
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-277-1604
Practice Address - Fax:336-277-9584
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVANT HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0527650004OtherDME NUMBER
NC0527650006OtherDME NUMBER
NC0527650007OtherDME NUMBER
NC0527650008OtherDME NUMBER
NC344504Medicare Oscar/Certification
NC0527650006OtherDME NUMBER