Provider Demographics
NPI:1316934235
Name:HOSPICE OF STANLY COUNTY, INC.
Entity type:Organization
Organization Name:HOSPICE OF STANLY COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-983-4216
Mailing Address - Street 1:960 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3350
Mailing Address - Country:US
Mailing Address - Phone:704-983-4216
Mailing Address - Fax:704-983-6662
Practice Address - Street 1:960 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-983-4216
Practice Address - Fax:704-983-6662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE OF STANLY COUNTY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS0402251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401542Medicaid
NC3401542Medicaid