Provider Demographics
NPI:1710002258
Name:OUR COMMUNITY HOSPITAL, INC
Entity Type:Organization
Organization Name:OUR COMMUNITY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-826-4144
Mailing Address - Street 1:921 JR HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874-1219
Mailing Address - Country:US
Mailing Address - Phone:252-826-4144
Mailing Address - Fax:
Practice Address - Street 1:921 JR HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-1219
Practice Address - Country:US
Practice Address - Phone:252-826-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9047314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920635Medicaid
NC205206DMedicare ID - Type Unspecified
NC8920635Medicaid