Basic Information
| Provider Information | |||||||||
| NPI: | 1083963227 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RALEIGH REGIONAL REHAB CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 10TH AVE N | ||||||||
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| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346953416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277975200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3830 BLUE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276124319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197814900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2012 | ||||||||
| LastUpdateDate: | 09/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | FISK | ||||||||
| AuthorizedOfficialFirstName: | TRINA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7277975200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0428 | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.