Healthcare Provider Details

I. General information

NPI: 1609515220
Provider Name (Legal Business Name): HENDERSON COUNTY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 BREVARD RD
ETOWAH NC
28729-8739
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 440
MORRISVILLE NC
27560-5491
US

V. Phone/Fax

Practice location:
  • Phone: 828-890-4156
  • Fax: 828-891-9276
Mailing address:
  • Phone: 984-974-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL LYNN SUNDAY JR.
Title or Position: VP, CHIEF FINANCIAL OFFICER
Credential:
Phone: 828-696-1175