Provider Demographics
NPI:1467489054
Name:LAKE NORMAN REGIONAL MEDICAL CENTER-HOME HEALTH
Entity Type:Organization
Organization Name:LAKE NORMAN REGIONAL MEDICAL CENTER-HOME HEALTH
Other - Org Name:LAKE NORMAN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-660-4010
Mailing Address - Street 1:170 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8541
Mailing Address - Country:US
Mailing Address - Phone:704-660-4480
Mailing Address - Fax:704-662-3312
Practice Address - Street 1:170 MEDICAL PARK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8541
Practice Address - Country:US
Practice Address - Phone:704-660-4480
Practice Address - Fax:704-662-3312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES, INC/LAKE NORMAN REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1325251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407215Medicaid
NC3407215Medicaid
NC347215Medicare PIN