Provider Demographics
NPI:1043475718
Name:ADVANCED REHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANCED REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANISA
Authorized Official - Middle Name:CHUN
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:704-865-6126
Mailing Address - Street 1:1437 E FRANKLIN BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4059
Mailing Address - Country:US
Mailing Address - Phone:704-865-6126
Mailing Address - Fax:704-865-4837
Practice Address - Street 1:1437 E FRANKLIN BLVD STE 128
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4059
Practice Address - Country:US
Practice Address - Phone:704-865-6126
Practice Address - Fax:704-865-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC888261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation