Organization
IREDELL MEMORIAL HOSP SNF ICF
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 28677-4107
(704) 873-5661
Mailing address
557 BROOKDALE DRIVE, STATESVILLE, NC 28677-4107
(704) 873-5661
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
H0164
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3496054
—
NC
Enumeration date
09/24/2007
Last updated
09/24/2007
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