Provider Demographics
NPI:1477846897
Name:COMMUNITY HOSPICE OF THE CAROLINAS, LLC
Entity Type:Organization
Organization Name:COMMUNITY HOSPICE OF THE CAROLINAS, LLC
Other - Org Name:REGENCY HOSPICE OF ANDREWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-664-2876
Mailing Address - Street 1:655 BRAWLEY SCHOOL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9125
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:704-664-1306
Practice Address - Street 1:64 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901-8109
Practice Address - Country:US
Practice Address - Phone:828-516-9475
Practice Address - Fax:877-564-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401597Medicaid
NC34-1597Medicare PIN