Provider Demographics
NPI:1467451088
Name:HOSPICE OF MCDOWELL COUNTY INC
Entity Type:Organization
Organization Name:HOSPICE OF MCDOWELL COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:W. RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKESSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-652-1318
Mailing Address - Street 1:575 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-3103
Mailing Address - Country:US
Mailing Address - Phone:828-652-1318
Mailing Address - Fax:828-659-1631
Practice Address - Street 1:575 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752
Practice Address - Country:US
Practice Address - Phone:828-652-1318
Practice Address - Fax:828-659-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS1153251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401573Medicaid
NC0024EOtherBLUE CROSS BLUE SHIELD
NC341573Medicare ID - Type Unspecified
NC3401573Medicaid