Basic Information
| Provider Information | |||||||||
| NPI: | 1982602538 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| 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: | 8282649155 | ||||||||
| FaxNumber: | 8282649154 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 SHADOWLINE DR | ||||||||
| Address2: | SUITE 100 B | ||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282649155 | ||||||||
| FaxNumber: | 8282649154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 06/08/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | METZGER | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8282649155 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN, MSN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HC0477 | NC | N | Agencies | Home Health | 251E00000X | HC0478 | NC | N | Agencies | Home Health | 251E00000X | HC0479 | NC | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 3417020 | 05 | NC | MEDICAID | 0070T | 01 | NC | BCBS OF NC | OTHER |