Provider Demographics
NPI:1730367467
Name:HOSPICE & PALLIATIVE CARECENTER
Entity type:Organization
Organization Name:HOSPICE & PALLIATIVE CARECENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-331-1260
Mailing Address - Street 1:101 HOSPICE LANE BLDG 141
Mailing Address - Street 2:HOSPICE AND PALLIATIVE CARE CENTER
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5766
Mailing Address - Country:US
Mailing Address - Phone:336-768-3972
Mailing Address - Fax:336-659-0461
Practice Address - Street 1:101 HOSPICE LN
Practice Address - Street 2:BLDG 141
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5766
Practice Address - Country:US
Practice Address - Phone:336-768-3972
Practice Address - Fax:336-659-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15115OtherMEDCOST
NC00735OtherBCBS HOMEHEALTH
NC0023AOtherBCBS HOSPICE
NC00735OtherBCBS HOMEHEALTH