=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285086959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW CENTURY HOSPICE OF RICHMOND, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2016
-----------------------------------------------------
Last Update Date | 01/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 S MAIN ST
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23847-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-634-0810
-----------------------------------------------------
Fax | 434-634-1023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 655 BRAWLEY SCHOOL RD SUITE 200
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-9125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-664-2876
-----------------------------------------------------
Fax | 704-664-1306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF LEGAL AFFAIRS
-----------------------------------------------------
Name | JESSICA KLEBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-662-0414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | HSP16206
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------