Provider Demographics
NPI:1346422847
Name:HOSPICE OF SURRY COUNTY, INC
Entity Type:Organization
Organization Name:HOSPICE OF SURRY COUNTY, INC
Other - Org Name:MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:336-789-2922
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-0325
Mailing Address - Country:US
Mailing Address - Phone:336-789-2922
Mailing Address - Fax:336-789-0856
Practice Address - Street 1:7599 CARROLLTON PIKE STE C
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-4269
Practice Address - Country:US
Practice Address - Phone:276-728-1030
Practice Address - Fax:276-728-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHSP-06123251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010254281Medicaid
VA010254281Medicaid