Provider Demographics
NPI:1588999684
Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Entity type:Organization
Organization Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:980-487-3802
Mailing Address - Street 1:PO BOX 60164
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0164
Mailing Address - Country:US
Mailing Address - Phone:980-487-7427
Mailing Address - Fax:980-487-7416
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:980-487-7427
Practice Address - Fax:980-487-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235034OtherMEDICARE PROFEE
NC8000197 (CRNA)Medicaid
NC260532OtherMEDICARE CRNA
NC8907691 (PROFEE)Medicaid
NC3400021Medicaid
NC8907691 (PROFEE)Medicaid