Provider Demographics
NPI:1689333544
Name:REBIRTH LLC
Entity Type:Organization
Organization Name:REBIRTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCAS, LAS
Authorized Official - Phone:910-373-7035
Mailing Address - Street 1:P.O. BOX 400
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364
Mailing Address - Country:US
Mailing Address - Phone:910-373-7035
Mailing Address - Fax:843-400-5045
Practice Address - Street 1:534 MCGIRT ROAD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364
Practice Address - Country:US
Practice Address - Phone:910-373-7035
Practice Address - Fax:843-400-5045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty