Provider Demographics
NPI:1487663654
Name:IN FORM HEALTHCARE, INC
Entity Type:Organization
Organization Name:IN FORM HEALTHCARE, INC
Other - Org Name:GUILFORD REHABILITATION ASSOCIATES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-761-5066
Mailing Address - Street 1:403 E PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1652
Mailing Address - Country:US
Mailing Address - Phone:336-317-9233
Mailing Address - Fax:
Practice Address - Street 1:403 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1652
Practice Address - Country:US
Practice Address - Phone:336-317-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC346641261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346641Medicare ID - Type UnspecifiedREHAB AGENCY