Organization
COMPLETE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEAN P DAVENPORT (OFFICE MGR)
(336) 778-0292
Entity
Organization
Contact information
Practice address
6000 MEADOW BROOK MALL, SUITE 22, CLEMMONS, NC 27012-8775
(336) 778-0292
(336) 778-0242
Mailing address
6000 MEADOW BROOK MALL, SUITE 22, CLEMMONS, NC 27012-8775
(336) 778-0292
(336) 778-0242
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0517000
UNITED HEALTH CARE
NC
01
—
10378967
NC VOCATIONAL REHAB
NC
01
—
135VA
BCBSNC
NC
01
—
64-01026
SECURE HORIZONS
NC
01
—
691687
ACN GROUP
—
05
—
7301751
—
NC
01
—
805848
PARTNERS
NC
01
—
BA1238
MEDCOST
NC
Enumeration date
08/14/2007
Last updated
04/18/2008
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