MEDICARE: HOSPICE OF GASTON COUNTY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	HC0812	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0021Y	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821097916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF GASTON COUNTY, INC

Provider Business Mailing Address
First Line	:	PO BOX 3984
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-0460
Country	:	US
Telephone Number	:	704-861-8405
Fax Number	:	704-865-0590

Provider Business Practice Location Address
First Line	:	258 E GARRISON BLVD
Second Line	:	WATER TOWER PLACE
City	:	GASTONIA
State	:	NC
Zip	:	28054-0460
Country	:	US
Telephone Number	:	704-861-8405
Fax Number	:	704-865-0590

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/15/2010

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Directions to “HOSPICE OF GASTON COUNTY, INC ” Practice Location

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