Basic Information
| Provider Information | |||||||||
| NPI: | 1164568986 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DURHAM BUSINESS ENTERPRISE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HENDERSONVILLE SPORTS AND REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 S KING ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286921333 | ||||||||
| FaxNumber: | 8286980048 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 S KING ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286921333 | ||||||||
| FaxNumber: | 8286980048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DURHAM | ||||||||
| AuthorizedOfficialFirstName: | DWAYNE | ||||||||
| AuthorizedOfficialMiddleName: | DOYCE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8286921333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ATC LAT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | 003 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.