Basic Information
| Provider Information | |||||||||
| NPI: | 1508869249 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOT SPRINGS HEALTH PROGRAM, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | MADISON HOME CARE OR HOSPICE OF MADISON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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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: | 287536807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286499566 | ||||||||
| FaxNumber: | 8286490687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2005 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STROM | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8286499566 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOT SPRINGS HEALTH PROGRAM, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HC0419 | NC | N | Agencies | Hospice Care, Community Based | 251E00000X | HC0419 | NC | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 3408161 | 05 | NC | MEDICAID | 3407039 | 05 | NC | MEDICAID | 3401540 | 05 | NC | MEDICAID | 00743 | 01 | NC | BCBS NC HH PROVIDER NO. | OTHER | 0022P | 01 | NC | BCBS NC HOS PROVIDER NO. | OTHER |