MEDICARE: CLEVELAND COUNTY HEALTHCARE SYSTEM

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	282N00000X	General Acute Care Hospital	943292	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972586691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND COUNTY HEALTHCARE SYSTEM

Provider Business Mailing Address
First Line	:	706 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2708
Country	:	US
Telephone Number	:	704-739-3601
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2708
Country	:	US
Telephone Number	:	704-739-3601
Fax Number	:

Authorized Official
Title or Position	:	COO/CNE
Name	:	SHERI DESHAZO
Credential	:	RN
Telephone Number	:	704-739-3601

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	08/22/2020

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