Provider Demographics
NPI:1073568754
Name:MOORESVILLE HOSPITAL MANAGEMENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:MOORESVILLE HOSPITAL MANAGEMENT ASSOCIATES LLC
Other - Org Name:LAKE NORMAN REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 281418
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1418
Mailing Address - Country:US
Mailing Address - Phone:704-660-4049
Mailing Address - Fax:704-660-4049
Practice Address - Street 1:171 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9500
Practice Address - Country:US
Practice Address - Phone:704-660-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
NCHO259282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
34U129OtherMEDICARE SWING BED UNIT
NC00318OtherBLUE CROSS
NC3400129Medicaid
34U129OtherMEDICARE SWING BED UNIT