Provider Demographics
NPI:1497763064
Name:MONTICELLO HOSPICE LLC
Entity Type:Organization
Organization Name:MONTICELLO HOSPICE LLC
Other - Org Name:MONTICELLO HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TUCKER
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-273-5550
Mailing Address - Street 1:405 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5556
Mailing Address - Country:US
Mailing Address - Phone:910-345-0030
Mailing Address - Fax:910-345-0041
Practice Address - Street 1:4720 HWY 17 BYPASS SOUTH
Practice Address - Street 2:SUITE F
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-293-6132
Practice Address - Fax:843-293-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC105163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty