Provider Demographics
NPI:1891800553
Name:NORTH CAROLINA REHAB, INC.
Entity Type:Organization
Organization Name:NORTH CAROLINA REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOTENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-379-9265
Mailing Address - Street 1:1 PARKWEST CIR
Mailing Address - Street 2:SUITE108
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5551
Mailing Address - Country:US
Mailing Address - Phone:804-379-9265
Mailing Address - Fax:804-379-9269
Practice Address - Street 1:133A S MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-1953
Practice Address - Country:US
Practice Address - Phone:252-257-0460
Practice Address - Fax:252-257-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346627Medicare ID - Type UnspecifiedMEDICARE