Provider Demographics
NPI:1275524621
Name:HOSPICE OF HENDERSON COUNTY, INC.
Entity Type:Organization
Organization Name:HOSPICE OF HENDERSON COUNTY, INC.
Other - Org Name:FOUR SEASONS THE CARE YOU TRUST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:BURKE-SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-6178
Mailing Address - Street 1:571 S ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9447
Mailing Address - Country:US
Mailing Address - Phone:828-692-6178
Mailing Address - Fax:828-233-0355
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9447
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-233-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS0386251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
2328856OtherMEDICARE GROUP #
NC3401530Medicaid
NC022JOtherBLUE CROSS BLUE SHIELD
NC5911482Medicaid
NC341530Medicare UPIN
NC5911482Medicaid