=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073568754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOORESVILLE HOSPITAL MANAGEMENT ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 04/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 FAIRVIEW RD
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-9500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-660-4010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 281418
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30384-1418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-660-4049
-----------------------------------------------------
Fax | 704-660-4049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/DELEGATED OFFICIAL
-----------------------------------------------------
Name | PAULA M LALOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 629-215-3953
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | HO259
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------