Provider Demographics
NPI:1093708711
Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Other - Org Name:KINGS MOUNTAIN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-487-3802
Mailing Address - Street 1:PO BOX 60548
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0548
Mailing Address - Country:US
Mailing Address - Phone:980-487-7427
Mailing Address - Fax:980-487-7416
Practice Address - Street 1:706 WEST KINGS STREET
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2708
Practice Address - Country:US
Practice Address - Phone:980-487-7427
Practice Address - Fax:980-487-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00303OtherBCBS
NC8000153OtherNC MEDICAID CRNA
NC235034GOtherMEDICARE PROFEE
NC8907690OtherNC MEDICAID PROFEE
NC235034HOtherMEDICARE CRNA
NC3400037Medicaid
NCNPA951OtherSC MEDICAID
NC3400037Medicaid