Basic Information
| Provider Information | |||||||||
| NPI: | 1417335670 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOT SPRINGS HEALTH PROGRAM, INC. | ||||||||
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| OtherOrganizationName: | HOT SPRINGS HEALTH PROGRAM OUTPATIENT SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69 | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287530069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286499566 | ||||||||
| FaxNumber: | 8286493786 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287536807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286499566 | ||||||||
| FaxNumber: | 8286493786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2015 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | STROM | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8286499566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.