Healthcare Provider Details

I. General information

NPI: 1821097916
Provider Name (Legal Business Name): HOSPICE OF GASTON COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 E GARRISON BLVD WATER TOWER PLACE
GASTONIA NC
28054-0460
US

IV. Provider business mailing address

PO BOX 3984
GASTONIA NC
28054-0460
US

V. Phone/Fax

Practice location:
  • Phone: 704-861-8405
  • Fax: 704-865-0590
Mailing address:
  • Phone: 704-861-8405
  • Fax: 704-865-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHC0812
License Number StateNC

VIII. Authorized Official

Name: MRS. LEONA T BUCCI
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, MS, CNA
Phone: 704-861-8405