Basic Information
Provider Information | |||||||||
NPI: | 1841441672 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CROSS CITY REHABILITATION & HEALTH CARE CENTER, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CROSS CITY REHABILITATION & HEALTH CARE CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3343 | ||||||||
Address2: |   | ||||||||
City: | HICKORY | ||||||||
State: | NC | ||||||||
PostalCode: | 286033343 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8283248898 | ||||||||
FaxNumber: | 8283229598 | ||||||||
Practice Location | |||||||||
Address1: | 583 NE 351 HWY | ||||||||
Address2: |   | ||||||||
City: | CROSS CITY | ||||||||
State: | FL | ||||||||
PostalCode: | 326283108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3524982005 | ||||||||
FaxNumber: | 3524982006 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/10/2008 | ||||||||
LastUpdateDate: | 10/10/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WOMACK | ||||||||
AuthorizedOfficialFirstName: | STEVEN | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
AuthorizedOfficialTelephone: | 8283248898 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | SNF130470998 | FL | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.