Provider Demographics
NPI:1932297249
Name:DAVIE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:DAVIE COUNTY HEALTH DEPARTMENT
Other - Org Name:HOSPICE OF DAVIE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:336-751-8700
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-0848
Mailing Address - Country:US
Mailing Address - Phone:336-751-8700
Mailing Address - Fax:336-751-0335
Practice Address - Street 1:642 WILKESBORO ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2051
Practice Address - Country:US
Practice Address - Phone:336-753-6200
Practice Address - Fax:336-751-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0496251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBCBS 000EOtherBLUECROSSBLUESHIELDNC