Provider Demographics
NPI:1114030756
Name:COMMUNITY HOSPICE, INC.
Entity Type:Organization
Organization Name:COMMUNITY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-771-3010
Mailing Address - Street 1:PO BOX 19150
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1150
Mailing Address - Country:US
Mailing Address - Phone:787-771-3010
Mailing Address - Fax:888-771-3022
Practice Address - Street 1:563 CALLE ALVERIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3725
Practice Address - Country:US
Practice Address - Phone:787-771-3010
Practice Address - Fax:888-771-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401550Medicare ID - Type Unspecified