Basic Information
| Provider Information | |||||||||
| NPI: | 1477846897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPICE OF THE CAROLINAS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REGENCY HOSPICE OF ANDREWS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 BRAWLEY SCHOOL RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046642876 | ||||||||
| FaxNumber: | 7046641306 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 MEMORIAL DRIVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ANDREWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 289018109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285169475 | ||||||||
| FaxNumber: | 8775645524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2011 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | ABELL | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL/SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7046642876 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 | 3401597 | 05 | NC | MEDICAID |