Provider Demographics
NPI:1093810822
Name:COMMUNITY HOSPICES OF AMERICA, LLC
Entity Type:Organization
Organization Name:COMMUNITY HOSPICES OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:10 CADILLAC DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5078
Mailing Address - Country:US
Mailing Address - Phone:615-425-5407
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:1330 MERCER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3066
Practice Address - Country:US
Practice Address - Phone:304-431-2000
Practice Address - Fax:304-431-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1081089251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005665000Medicaid
WV0005665001Medicaid
WV0005665001Medicaid
WV511505Medicare Oscar/Certification