Provider Demographics
NPI:1194853325
Name:MISSION HOSPITALS LIFELINE PROGRAM
Entity Type:Organization
Organization Name:MISSION HOSPITALS LIFELINE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CASSADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-213-4880
Mailing Address - Street 1:428 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4502
Mailing Address - Country:US
Mailing Address - Phone:828-213-4880
Mailing Address - Fax:828-213-4899
Practice Address - Street 1:345 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4119
Practice Address - Country:US
Practice Address - Phone:828-213-4880
Practice Address - Fax:828-213-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408456Medicaid