Provider Demographics
| NPI: | 1033440326 |
|---|---|
| Name: | UNITED HEALTH REHABILITATION SERVICES, LLC. |
| Entity Type: | Organization |
| Organization Name: | UNITED HEALTH REHABILITATION SERVICES, LLC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | CLEM |
| Authorized Official - Middle Name: | CHIEMEKA |
| Authorized Official - Last Name: | IHEANACHO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD |
| Authorized Official - Phone: | 336-271-6800 |
| Mailing Address - Street 1: | 1314 HEADQUARTERS DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GREENSBORO |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27405-7920 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 336-271-6800 |
| Mailing Address - Fax: | 336-271-6862 |
| Practice Address - Street 1: | 1314 HEADQUARTERS DR |
| Practice Address - Street 2: | |
| Practice Address - City: | GREENSBORO |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27405-7920 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 336-271-6800 |
| Practice Address - Fax: | 336-271-6862 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-01-26 |
| Last Update Date: | 2012-08-01 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NC | 1138 | 101Y00000X |
| 101YA0400X, 101YM0800X, 101YP2500X, 103T00000X, 103TA0400X, 104100000X, 1041C0700X, 106H00000X, 251B00000X, 363AM0700X, 363L00000X, 363LF0000X, 363LP0808X, 364SP0808X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Single Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Single Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Single Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Single Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Single Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Single Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Single Specialty |
