Basic Information
| Provider Information | |||||||||
| NPI: | 1336243997 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE OF IREDELL COUNTY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2347 SIMONTON RD | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286258246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048734719 | ||||||||
| FaxNumber: | 7048721810 | ||||||||
| Practice Location | |||||||||
| Address1: | 2347 SIMONTON RD | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286258246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048734719 | ||||||||
| FaxNumber: | 7048721810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 07/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 7048734719 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 3401517 | 05 | NC | MEDICAID |