Provider Demographics
NPI:1144270372
Name:CAROLINA COMPLETE REHAB CENTER OF HOPE MILLS INC
Entity type:Organization
Organization Name:CAROLINA COMPLETE REHAB CENTER OF HOPE MILLS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:LAURELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-429-0600
Mailing Address - Street 1:4251 LEGION RD STE 107
Mailing Address - Street 2:P.O. BOX 408
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-6200
Mailing Address - Country:US
Mailing Address - Phone:910-429-0600
Mailing Address - Fax:910-429-0602
Practice Address - Street 1:4251 LEGION RD
Practice Address - Street 2:STE 107
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-6201
Practice Address - Country:US
Practice Address - Phone:910-429-0600
Practice Address - Fax:910-429-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012EWOtherBCBS
NC7211570Medicaid
NC015UTOtherBCBS
NC7211284Medicaid
NC2503905AMedicare PIN
NC7211284Medicaid