1730367467 NPI number — HOSPICE & PALLIATIVE CARECENTER

Table of content: (NPI 1730367467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730367467 NPI number — HOSPICE & PALLIATIVE CARECENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE & PALLIATIVE CARECENTER
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:
TRELLIS SUPPORTIVE CARE
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:
1730367467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HOSPICE LANE BLDG 141
Provider Second Line Business Mailing Address:
HOSPICE AND PALLIATIVE CARE CENTER
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-5766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-768-3972
Provider Business Mailing Address Fax Number:
336-659-0461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HOSPICE LN
Provider Second Line Business Practice Location Address:
BLDG 141
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-5766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-768-3972
Provider Business Practice Location Address Fax Number:
336-659-0461
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
336-331-1260

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15115 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 00735 . This is a "BCBS HOMEHEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0023A . This is a "BCBS HOSPICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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