Provider Demographics
NPI:1114966249
Name:MOORESVILLE HOSPITAL MANAGEMENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:MOORESVILLE HOSPITAL MANAGEMENT ASSOCIATES LLC
Other - Org Name:LAKE NORMAN REGIONAL MEDICAL CENTER HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:170 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8541
Mailing Address - Country:US
Mailing Address - Phone:704-660-4480
Mailing Address - Fax:704-662-3312
Practice Address - Street 1:170 MEDICAL PARK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8541
Practice Address - Country:US
Practice Address - Phone:704-660-4480
Practice Address - Fax:704-662-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1325NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407215Medicaid
NC00318OtherBC NC
NC3417215Medicaid
347215Medicare Oscar/Certification