Provider Demographics
NPI:1134126774
Name:COMMUNITY HOSPICE OF NORTHEAST FLORIDA INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPICE OF NORTHEAST FLORIDA INC
Other - Org Name:COMMUNITY HOSPICE OF N.E. FLORIDA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-268-5200
Mailing Address - Street 1:4266 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6030
Mailing Address - Country:US
Mailing Address - Phone:904-268-5200
Mailing Address - Fax:904-596-6200
Practice Address - Street 1:4266 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6030
Practice Address - Country:US
Practice Address - Phone:904-268-5200
Practice Address - Fax:904-596-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5024096251G00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Not Answered315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
10-1500Medicare ID - Type Unspecified