Healthcare Provider Details

I. General information

NPI: 1497763064
Provider Name (Legal Business Name): MONTICELLO HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 HWY 17 BYPASS SOUTH SUITE F
MYRTLE BEACH SC
29577
US

IV. Provider business mailing address

405 N ELM ST
LUMBERTON NC
28358-5556
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-6132
  • Fax: 843-293-6133
Mailing address:
  • Phone: 910-345-0030
  • Fax: 910-345-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberHPC105
License Number StateSC

VIII. Authorized Official

Name: ROBERT TUCKER REED
Title or Position: CHEIF OPERATING OFFICER
Credential:
Phone: 910-273-5550