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Organization
PETTIGREW REHABILITATION CENTER, LLC
Active
Organization
PETTIGREW REHABILITATION CENTER, LLC
Active
Other names
Pettigrew Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. R. MARK CRONQUIST (MANAGER)
(404) 574-2100
Entity
Organization
Contact information
Practice address
1515 W PETTIGREW ST, DURHAM, NC 27705-4821
(919) 286-0751
(919) 286-7065
Mailing address
5887 GLENRIDGE DR, SUITE 150, ATLANTA, GA 30328-5574
(404) 574-2100
(404) 574-2105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0119
NC
314000000X
Skilled Nursing Facility
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144646274
—
NC
Enumeration date
03/13/2014
Last updated
09/29/2014
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