Provider Demographics
NPI:1760450464
Name:LOWER CAPE FEAR HOSPICE INCORPORATED
Entity Type:Organization
Organization Name:LOWER CAPE FEAR HOSPICE INCORPORATED
Other - Org Name:LOWER CAPE FEAR LIFE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-796-8000
Mailing Address - Street 1:1414 PHYSICIANS DR.
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7335
Mailing Address - Country:US
Mailing Address - Phone:910-796-7957
Mailing Address - Fax:910-341-1908
Practice Address - Street 1:2970 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5244
Practice Address - Country:US
Practice Address - Phone:910-577-6660
Practice Address - Fax:910-796-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0531251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00772OtherBLUE CROSS & BLUE SHIELD
NC3407070Medicaid
NC566000326010OtherTRICARE
NC=========010OtherTRICARE