Provider Demographics
NPI:1659300770
Name:HOSPICE & PALLIATIVE CARECENTER
Entity Type:Organization
Organization Name:HOSPICE & PALLIATIVE CARECENTER
Other - Org Name:TRELLIS SUPPORTIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-331-1260
Mailing Address - Street 1:101 HOSPICE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5766
Mailing Address - Country:US
Mailing Address - Phone:336-768-3972
Mailing Address - Fax:336-659-0461
Practice Address - Street 1:101 HOSPICE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5766
Practice Address - Country:US
Practice Address - Phone:336-768-3972
Practice Address - Fax:336-659-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0409251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401502Medicaid
NC6600079Medicaid
NC28048OtherPARTNERS HOMEHEALTH
NC3407106Medicaid
NC41731OtherPARTNERS HOSPICE
NC0023AOtherBCBS HOSPICE
NC00735OtherBCBS HOMEHEALTH
NC3401502Medicaid
NC347106Medicare Oscar/Certification
NC341502Medicare Oscar/Certification