Provider Demographics
NPI:1144221078
Name:STOKES REYNOLDS MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:STOKES REYNOLDS MEMORIAL HOSPITAL, INC.
Other - Org Name:HOSPICE OF STOKES COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPICE OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-593-5348
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016-0010
Mailing Address - Country:US
Mailing Address - Phone:336-593-5348
Mailing Address - Fax:336-593-5354
Practice Address - Street 1:1570 HIGHWAY 8 & 89 N
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016
Practice Address - Country:US
Practice Address - Phone:336-593-5348
Practice Address - Fax:336-593-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS0554251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3411525Medicaid
NC341525Medicare Oscar/Certification