Provider Demographics
NPI:1407004963
Name:MERCY RESTORATIVE CARE HOSPITAL, INC
Entity Type:Organization
Organization Name:MERCY RESTORATIVE CARE HOSPITAL, INC
Other - Org Name:CAROLINAS SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-887-7283
Mailing Address - Street 1:2001 VAIL AVE
Mailing Address - Street 2:SEVENTH FLOOR SOUTH
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1219
Mailing Address - Country:US
Mailing Address - Phone:704-335-9113
Mailing Address - Fax:
Practice Address - Street 1:2001 VAIL AVE
Practice Address - Street 2:SEVENTH FLOOR SOUTH
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1219
Practice Address - Country:US
Practice Address - Phone:704-335-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2352781OtherMEDICARE GROUP PROVIDER NUMBER