Basic Information
| Provider Information | |||||||||
| NPI: | 1992740468 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLETCHER HOSPITAL INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ADVENTHEALTH HOME CARE WESTERN NORTH CAROLINA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 948117 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303948117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286875616 | ||||||||
| FaxNumber: | 8286508076 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286875261 | ||||||||
| FaxNumber: | 8286875281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 04/25/2019 | ||||||||
| NPIReactivationDate: | 05/14/2019 | ||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STENSTROM | ||||||||
| AuthorizedOfficialFirstName: | ELLA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8286812102 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FLETCHER HOSPITAL INC. | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HCO911 | NC | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 347195 | 01 | NC | UNICARE SECURITY CHC MCR | OTHER | 347195 | 01 | NC | ANTHEM SENIOR ADVANTAGE | OTHER | 347195 | 01 | NC | HUMANA INS GOLD CHC MCR | OTHER | 0007381246 | 01 | NC | AETNA | OTHER | 347195 | 01 | NC | PARTNERS NTL HLTH PLN | OTHER | 007CT | 01 | NC | BLUE CROSS BLUE SHIELD NC | OTHER | 152185700 | 01 | NC | US DEPT OF LABOR WC | OTHER | 3407195 | 05 | NC | MEDICAID | 347195 | 01 | NC | UNITED HEALTHCARE | OTHER | 347195 | 01 | NC | PACIFICARE MCR | OTHER |