Provider Demographics
NPI:1861441719
Name:CAROLINA THERAPY CENTER LLC
Entity Type:Organization
Organization Name:CAROLINA THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRISHKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-544-5244
Mailing Address - Street 1:7215 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-6173
Mailing Address - Country:US
Mailing Address - Phone:704-544-5244
Mailing Address - Fax:704-544-5224
Practice Address - Street 1:7215 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6173
Practice Address - Country:US
Practice Address - Phone:704-544-5244
Practice Address - Fax:704-544-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122951261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344520Medicare ID - Type UnspecifiedPROVIDER NUMBER