Basic Information
| Provider Information | |||||||||
| NPI: | 1205894029 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOUNDATION HEALTH SYSTEMS CORP. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NOVANT HEALTH REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601791 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367518003 | ||||||||
| FaxNumber: | 3367518030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1903 S HAWTHORNE RD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367186700 | ||||||||
| FaxNumber: | 3367186798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GOODNIGHT | ||||||||
| AuthorizedOfficialFirstName: | CRESS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER REGIONAL REHAB SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7047984494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 0527650008 | 01 | NC | DME NUMBER | OTHER | 0527650006 | 01 | NC | DME NUMBER | OTHER | 0527650007 | 01 | NC | DME NUMBER | OTHER | 0527650004 | 01 | NC | DME NUMBER | OTHER |