Basic Information
| Provider Information | |||||||||
| NPI: | 1386712768 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENDERSON/VANCE HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 566 RUIN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275362927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524384143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 566 RUIN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275362927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524384143 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 12/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | CHATMAN | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE CFO | ||||||||
| AuthorizedOfficialTelephone: | 2524361101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H0267 | NC | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 3400132 | 05 | NC | MEDICAID |