Healthcare Provider Details

I. General information

NPI: 1972876399
Provider Name (Legal Business Name): HOSPICE OF RUTHERFORD COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 HUDLOW RD
FOREST CITY NC
28043-9444
US

IV. Provider business mailing address

374 HUDLOW RD
FOREST CITY NC
28043-9444
US

V. Phone/Fax

Practice location:
  • Phone: 828-245-8471
  • Fax: 828-248-1378
Mailing address:
  • Phone: 828-245-8471
  • Fax: 828-248-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9400625
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100690
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number138928
License Number StateNC

VIII. Authorized Official

Name: RITA R BURCH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-245-0095