Provider Demographics
NPI:1245233675
Name:HOT SPRINGS HEALTH PROGRAM
Entity Type:Organization
Organization Name:HOT SPRINGS HEALTH PROGRAM
Other - Org Name:MADISON HOME CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME CARE BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-649-9566
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-0069
Mailing Address - Country:US
Mailing Address - Phone:828-649-9566
Mailing Address - Fax:828-649-0687
Practice Address - Street 1:590 MEDICAL PARK DR.
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753
Practice Address - Country:US
Practice Address - Phone:828-649-9566
Practice Address - Fax:828-649-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0419251C00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408161Medicaid