Provider Demographics
NPI:1225351539
Name:HOSPICE OF CLEVELAND COUNTY, INC
Entity Type:Organization
Organization Name:HOSPICE OF CLEVELAND COUNTY, INC
Other - Org Name:PALLIATIVE CARE CLEVELAND COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-487-4677
Mailing Address - Street 1:951 WENDOVER HEIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3565
Mailing Address - Country:US
Mailing Address - Phone:704-487-4677
Mailing Address - Fax:704-751-3555
Practice Address - Street 1:951 WENDOVER HEIGHT DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3565
Practice Address - Country:US
Practice Address - Phone:704-487-4677
Practice Address - Fax:704-751-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2340801Medicare PIN