1275536427 NPI number — HOSPICE OF CLEVELAND COUNTY, INC.

Table of content: (NPI 1275536427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275536427 NPI number — HOSPICE OF CLEVELAND COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF CLEVELAND COUNTY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOSPICE CLEVELAND COUNTY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275536427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
951 WENDOVER HEIGHT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28150-3565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-487-4677
Provider Business Mailing Address Fax Number:
704-481-8050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 WENDOVER HEIGHT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-3565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-487-4677
Provider Business Practice Location Address Fax Number:
704-481-8050
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BEAM
Authorized Official First Name:
JASON
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
704-487-4677

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HOS0371 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: HOS1413 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X , with the licence number: HPC-065 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 355808 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3401520 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP045 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2497670 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0022W . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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