# IREDELL MEMORIAL HOSPITAL INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Iredell Memorial Hospital Skilled Nursing Facility
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760462196
- **Authorized official:** GARY SMITH (CFO)
- **Authorized official phone:** (704) 878-4505

## Contact information

- **Practice address:** 557 BROOKDALE DR, STATESVILLE, NC 28677-4107
- **Practice address phone:** (704) 873-5661
- **Practice address fax:** (704) 878-4611
- **Mailing address:** 557 BROOKDALE DR, STATESVILLE, NC 28677-4107
- **Mailing address phone:** (704) 873-5661
- **Mailing address fax:** (704) 878-4611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | H0164 | NC | Yes |

## Other

- **Enumeration date:** 01/20/2006
- **Last updated:** 06/24/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3405306 | — | NC |