Basic Information
| Provider Information | |||||||||
| NPI: | 1043304975 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY OF NORTH CAROLINA HOSPITALS AT CHAPEL HILL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNC HOSPITALS REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5221 PARAMOUNT PKWY STE 440 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275605491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741190 | ||||||||
| FaxNumber: | 9849741311 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 WATERSTONE DR | ||||||||
| Address2: | |||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272789078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849740340 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HADAR | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | TERESA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, UNC HOSPITALS | ||||||||
| AuthorizedOfficialTelephone: | 9849742819 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNIVERSITY OF NORTH CAROLINA HOSPITALS AT CHAPEL HILL | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | H0157 | NC | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 001AR | 01 | NC | BCBSNC REHAB PROV # | OTHER | 3400061T | 05 | NC | MEDICAID |