Provider Demographics
NPI:1790875953
Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Other - Org Name:KINGS MOUNTAIN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-487-3802
Mailing Address - Street 1:PO BOX 60548
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0548
Mailing Address - Country:US
Mailing Address - Phone:704-739-3601
Mailing Address - Fax:980-487-7416
Practice Address - Street 1:706 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2708
Practice Address - Country:US
Practice Address - Phone:704-739-3601
Practice Address - Fax:980-487-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0113273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC198264OtherSC MEDICAID UB
NC3400037SMedicaid
NC8907690Medicaid
NCNPA951OtherSC MEDICAID
NC34S037Medicare Oscar/Certification