Provider Demographics
NPI:1649360686
Name:CAWH REHABILITATION SERVICES, LLC.
Entity type:Organization
Organization Name:CAWH REHABILITATION SERVICES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-622-9641
Mailing Address - Street 1:10116 OLD LIBERTY RD
Mailing Address - Street 2:PO BOX 486
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-8072
Mailing Address - Country:US
Mailing Address - Phone:336-622-9641
Mailing Address - Fax:336-622-9713
Practice Address - Street 1:10116 OLD LIBERTY RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-8072
Practice Address - Country:US
Practice Address - Phone:336-622-9641
Practice Address - Fax:336-622-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01954OtherBCBS NC
NCCG1301OtherMEDICARE RAILROAD
VADF0075OtherMEDICARE RAILROAD
VA1023023678OtherNPI VA
NC0007729125OtherAETNA
VA193617OtherANTHEM
VA193615OtherANTHEM
NC2503499Medicare PIN
NC0007729125OtherAETNA