Healthcare Provider Details

I. General information

NPI: 1174124614
Provider Name (Legal Business Name): HOSPICE OF STANLY COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 N 1ST ST
ALBEMARLE NC
28001-3350
US

IV. Provider business mailing address

960 N 1ST ST
ALBEMARLE NC
28001-3350
US

V. Phone/Fax

Practice location:
  • Phone: 704-983-4216
  • Fax: 704-983-6662
Mailing address:
  • Phone: 704-983-4216
  • Fax: 704-983-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI S. THAYER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-983-4216