Provider Demographics
NPI:1508869249
Name:HOT SPRINGS HEALTH PROGRAM, INC.
Entity Type:Organization
Organization Name:HOT SPRINGS HEALTH PROGRAM, INC.
Other - Org Name:MADISON HOME CARE OR HOSPICE OF MADISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:B
Authorized Official - Last Name:STROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-649-9566
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-0069
Mailing Address - Country:US
Mailing Address - Phone:828-649-9566
Mailing Address - Fax:828-649-0687
Practice Address - Street 1:590 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6807
Practice Address - Country:US
Practice Address - Phone:828-649-9566
Practice Address - Fax:828-649-0687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOT SPRINGS HEALTH PROGRAM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-25
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0419251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408161Medicaid
NC3407039Medicaid
NC3401540Medicaid
NC00743OtherBCBS NC HH PROVIDER NO.
NC0022POtherBCBS NC HOS PROVIDER NO.
NC3408161Medicaid
NC=========-003OtherTRICARE PROVIDER NO.
NC3408161Medicaid
NC3408161Medicaid
NC347039Medicare Oscar/Certification