Organization
IMH PROFESSIONAL PATH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ED RUSH (PRESIDENT)
(704) 873-5661
Entity
Organization
Contact information
Practice address
557 BROOKDALE DRIVE, STATESVILLE, NC 28677
(704) 873-5661
(704) 878-4611
Mailing address
557 BROOKDALE DRIVE, STATESVILLE, NC 28677
(704) 873-5661
(704) 878-4611
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8907674
—
NC
Enumeration date
01/26/2006
Last updated
08/22/2020
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