Provider Demographics
NPI:1912962697
Name:LOWER CAPE FEAR HOSPICE INCORPORATED
Entity Type:Organization
Organization Name:LOWER CAPE FEAR HOSPICE INCORPORATED
Other - Org Name:LOWER CAPE FEAR LIFECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-796-7900
Mailing Address - Street 1:1414 PHYSICIANS DRIVE
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:910-796-7900
Mailing Address - Fax:910-796-7901
Practice Address - Street 1:1414 PHYSICIANS DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7335
Practice Address - Country:US
Practice Address - Phone:910-796-7900
Practice Address - Fax:910-796-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2121207RH0002X
NCHOS0416251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012N8OtherBLUE CROSS/BLUE SHIELD
NC89012N8Medicaid
NC3401515Medicaid
NC0021ROtherBLUE CROSS/BLUE SHIELD
NC012N8OtherBLUE CROSS/BLUE SHIELD
NC3401515Medicaid