Provider Demographics
NPI:1962505313
Name:MARGATE HEALTH AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:MARGATE HEALTH AND REHAB CENTER LLC
Other - Org Name:THE MARGATE HEALTH AND REHAB CENTER OF JEFFERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HARTWELL
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-492-2994
Mailing Address - Street 1:540 WAUGH STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0130
Mailing Address - Country:US
Mailing Address - Phone:336-246-5581
Mailing Address - Fax:336-246-5997
Practice Address - Street 1:540 WAUGH STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-0130
Practice Address - Country:US
Practice Address - Phone:336-246-5581
Practice Address - Fax:336-246-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
NCNH0459314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3435296OtherMEDICAID
NC3436466Medicaid
NC3436466Medicaid