Basic Information
| Provider Information | |||||||||
| NPI: | 1639172299 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE OF ROCKINGHAM COUNTY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 NC HIGHWAY 65 | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273209609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364279022 | ||||||||
| FaxNumber: | 3364279030 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 NC HIGHWAY 65 | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273209609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364279022 | ||||||||
| FaxNumber: | 3364279030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | FLANAGAN | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | PARKER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3364279022 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, MSN, CHPN | ||||||||
| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 3401529 | 05 | NC | MEDICAID |