Basic Information
| Provider Information | |||||||||
| NPI: | 1770582363 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REX HOSPITAL, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNC REX REHABILITATION AND NURSING CARE CENTER OF APEX | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 S HUGHES ST | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275027731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193636011 | ||||||||
| FaxNumber: | 9193636014 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 S HUGHES ST | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275027731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193636011 | ||||||||
| FaxNumber: | 9193636014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ZUKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | KENNETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9197846422 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | NH0594 | NC | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | NH0594 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 340613G | 05 | NC | MEDICAID | 009AF | 01 | NC | BLUE CROSS | OTHER | 5615609260 | 01 | NC | AMERICAN REPUBLIC | OTHER | 71-52480 | 01 | NC | UNITED MEDICARE COMPLETE | OTHER | XXXXXXXX9261 | 01 | NC | AETNA | OTHER | 3405508 | 05 | NC | MEDICAID | 5615092610003 | 01 | NC | CHAMPUS/TRICARE | OTHER | AN67485140001 | 01 | NC | PARTNERS | OTHER |