Healthcare Provider Details

I. General information

NPI: 1417335670
Provider Name (Legal Business Name): HOT SPRINGS HEALTH PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL PARK DR
MARSHALL NC
28753-6807
US

IV. Provider business mailing address

PO BOX 69
MARSHALL NC
28753-0069
US

V. Phone/Fax

Practice location:
  • Phone: 828-649-9566
  • Fax: 828-649-3786
Mailing address:
  • Phone: 828-649-9566
  • Fax: 828-649-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TERESA B STROM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-649-9566