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Organization

LEGACY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JAYME MICHELE BOURGEOIS OTA/L (OCCUPATIONAL THERAPY ASSISTANT)
(919) 435-1284
Entity
Organization

Contact information

Practice address
2275 RUIN CREEK RD, HENDERSON, NC 27537-8732
(252) 492-0066
Mailing address
2275 RUIN CREEK ROAD, HENDERSON, NC 27537
(252) 492-0066

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5022
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5022
OTA/L
NC
Enumeration date
07/05/2013
Last updated
07/05/2013
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