Provider Demographics
NPI:1821097916
Name:HOSPICE OF GASTON COUNTY, INC
Entity Type:Organization
Organization Name:HOSPICE OF GASTON COUNTY, INC
Other - Org Name:GASTON HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, CNA
Authorized Official - Phone:704-861-8405
Mailing Address - Street 1:PO BOX 3984
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0460
Mailing Address - Country:US
Mailing Address - Phone:704-861-8405
Mailing Address - Fax:704-865-0590
Practice Address - Street 1:258 E GARRISON BLVD
Practice Address - Street 2:WATER TOWER PLACE
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0460
Practice Address - Country:US
Practice Address - Phone:704-861-8405
Practice Address - Fax:704-865-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0812251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0021YOtherBLUE CROSS BLUE SHIELD
NC3401536Medicaid
NC341536Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER