# PETTIGREW REHABILITATION CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pettigrew Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144646274
- **Authorized official:** MR. R. MARK CRONQUIST (MANAGER)
- **Authorized official phone:** (404) 574-2100

## Contact information

- **Practice address:** 1515 W PETTIGREW ST, DURHAM, NC 27705-4821
- **Practice address phone:** (919) 286-0751
- **Practice address fax:** (919) 286-7065
- **Mailing address:** 5887 GLENRIDGE DR, SUITE 150, ATLANTA, GA 30328-5574
- **Mailing address phone:** (404) 574-2100
- **Mailing address fax:** (404) 574-2105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0119 | NC | Yes |
| 314000000X | Skilled Nursing Facility | — | NULL | — |

## Other

- **Enumeration date:** 03/13/2014
- **Last updated:** 09/29/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1144646274 | — | NC |