Basic Information
| Provider Information | |||||||||
| NPI: | 1245233675 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOT SPRINGS HEALTH PROGRAM | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MADISON HOME CARE AND HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69 | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287530069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286499566 | ||||||||
| FaxNumber: | 8286490687 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 MEDICAL PARK DR. | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286499566 | ||||||||
| FaxNumber: | 8286490687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GREGG | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | HOME CARE BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8286499566 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | HC0419 | NC | X | Agencies | Day Training, Developmentally Disabled Services | 251E00000X | HC0419 | NC | X | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 3408161 | 05 | NC | MEDICAID |