Basic Information
| Provider Information | |||||||||
| NPI: | 1689604209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGH COUNTRY HEALTH CARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 SHADOWLINE DR | ||||||||
| Address2: | SUITE 100-B | ||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282653388 | ||||||||
| FaxNumber: | 8282649154 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 SHADOWLINE DR | ||||||||
| Address2: | SUITE 100-B | ||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282653388 | ||||||||
| FaxNumber: | 8282649154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | METZGER | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8282653388 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HOS1122 | NC | N | Agencies | Hospice Care, Community Based | 251G00000X | HOS1124 | NC | N | Agencies | Hospice Care, Community Based | 251G00000X | HOS1123 | NC | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 3411539 | 05 | NC | MEDICAID |