1295869857 NPI number — HUGH CHATHAM MEMORIAL HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295869857 NPI number — HUGH CHATHAM MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUGH CHATHAM MEMORIAL HOSPITAL, 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:
HUGH CHATHAM REGIONAL REHABILITATION CENTER
Provider Other Organization Name Type Code:
5
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:
1295869857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 560
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28621-0560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-527-7000
Provider Business Mailing Address Fax Number:
336-526-6056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 PARKWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28621-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-527-7000
Provider Business Practice Location Address Fax Number:
336-526-6056
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PENNINGTON
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
336-527-7312

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  H0049 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00111 . This is a "BLUE CROSS ACUTE REHAB" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 900HOS . This is a "PARTNERS ACUTE REHAB" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3400097 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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