Hospice & Palliative Care of the Blue Ridge Inc
Organization Active NPI Exclusive Provider Organization · Spruce Pine, NC
NPI 1023084399 · NPPES record last updated Apr 9, 2024
Key facts
- NPI
- 1023084399
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Exclusive Provider Organization 302F00000X
- License
- HOS0832 (NC)
- Legal business name
- HOSPICE & PALLIATIVE CARE OF THE BLUE RIDGE INC
- Practice address
- 236 Hospital Dr
Spruce Pine, NC 28777-8944 - Phone
- (828) 765-5677
- Fax
- (828) 765-5680
- NPI assigned
- Feb 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Sheila Meadows Williams
- Title
- Cfo
- Phone
- (828) 765-5677
Practitioners 78
-
Joseph David Barker, M.D.
-
Becky R Guthrie, FNP-BC
-
Jennifer Ellen Larson, M.D.
-
Sandy Aubrey Lusk, FNP
-
Robin Baskin, PMHNP
-
Lois E Bernard, L.C.S.W.
-
April Jean Boyle, LCSW
-
Paul Benedict Burns, LCSW
-
Kaitlyn Elizabeth Callahan-King, L.C.S.W.
-
David Raymond Cameron, LCSW
-
John J Carter, M.D.
-
Louise L. Cate, MSW, LCSW
-
Robert Stephen Cefalu, LCSW
-
Marsha L.C. Coe, LCSW
-
Jarod Matthew Coffey, LCSW
-
Meredith Moore Comer, LCSW
-
Barbara A. Crosby, A.R.N.P.
-
Vanessa Anne Davy, LCSW
-
Jeanne Day, LCSW
-
Thomas W Duvall Jr., LCSW
Affiliated clinicians 23
-
McKenzie Dee Angel, APRN
-
Joseph David Barker, M.D.
-
Katherine Grimes Crum, M.D.
-
Stephen Kimmel, MD
-
Joshua M Newton, PA
-
Stephen William North, M.D.
-
Karen Peterson, FNP
-
Dan Radulescu, ANP
-
Dwight James Willett, M.D.
-
Ashley Williams, NP-C
-
Tiffany Woody, FNP-C
Medicare Care Compare: Hospice
- Listed as
- Hospice & Palliative Care of the Blue Ridge, Inc
- Ownership
- Non-Profit
- Certified
- Aug 9, 1993
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2144776 | Hospice and Palliative Care of the Blue Ridge | Certificate of waiver | Feb 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Hospice certification: CCN 341565
- Legal name
- HOSPICE & PALLIATIVE CARE OF THE BLUE RIDGE INC
- Doing business as
- HOSPICE OF MITCHELL COUNTY
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 9, 1993
- Last certification
- Nov 23, 2013
- Ownership / control type
- Non-Profit - Other
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 8, 1997 in NC
- Enrollment address
- 236 Hospital Dr
Spruce Pine, NC 28777-8944
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Christina H Jenkins |
5% Or Greater Direct Ownership Interest |
Jun 1, 2012 | |
| Corporate Director |
Jun 1, 2012 | ||
| Sheila Williams |
Corporate Officer |
Jun 1, 2015 | |
| W-2 Managing Employee |
Jun 1, 2015 | ||
| Operational/Managerial Control |
Jun 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120409000594 | NC | Part a Provider - Hospice | 6103087762 | Practice locations: Spruce Pine, NC |
| O20140722001098 | NC | Part B Supplier - Clinic/Group Practice | 6103087762 |
Receives reassigned benefits from 6 practitioners Practice locations: Spruce Pine, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | |||
| Nursing Care Agency | 251J00000X | |||
| In Home Supportive Care Agency | 253Z00000X | |||
| Exclusive Provider Organization | 302F00000X | HOS0832 | NC | Yes |
| Respite Care | 385H00000X |
Addresses
Primary practice location
236 Hospital Dr
Spruce Pine, NC 28777-8944
Mailing address
236 Hospital Dr
Spruce Pine, NC 28777-8944
Phone (828) 765-5677
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3401565 | Medicaid | NC |
Other providers in Spruce Pine, NC
- Kaitlyn Hobbs
- Meredith Burleson Hoilman
- Deborah Deoss Holcomb
- Timothy Scott Holcomb
- William E. Hollamon Jr.
- Hospital Drive Pharmacy Inc
- Hospital Drive Pharmacy, Inc.
- John Wesley Hughes
- Ingles Markets Inc
- Jo Ellen Inman-Puckett
All providers in Spruce Pine, NC · Exclusive Provider Organization in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.