Provider Demographics
NPI:1316221633
Name:SURRY COUNTY CONVALESCENT SERVICES
Entity Type:Organization
Organization Name:SURRY COUNTY CONVALESCENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:336-783-9000
Mailing Address - Street 1:1218 STATE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5001
Mailing Address - Country:US
Mailing Address - Phone:336-783-9000
Mailing Address - Fax:336-783-9010
Practice Address - Street 1:1218 STATE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5001
Practice Address - Country:US
Practice Address - Phone:336-783-9000
Practice Address - Fax:336-783-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport