Provider Demographics
NPI:1023380326
Name:REBOUND SOLUTIONS, LLC
Entity type:Organization
Organization Name:REBOUND SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-492-8715
Mailing Address - Street 1:523 S CHESTNUT ST
Mailing Address - Street 2:P O BOX 1267
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4102
Mailing Address - Country:US
Mailing Address - Phone:252-492-8715
Mailing Address - Fax:252-492-8124
Practice Address - Street 1:523 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4102
Practice Address - Country:US
Practice Address - Phone:252-492-8715
Practice Address - Fax:252-492-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid