Provider Demographics
NPI:1265822183
Name:COMMONWEALTH HOSPICE LLC
Entity Type:Organization
Organization Name:COMMONWEALTH HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-726-9541
Mailing Address - Street 1:36 WASHINGTON ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1900
Mailing Address - Country:US
Mailing Address - Phone:508-726-9541
Mailing Address - Fax:
Practice Address - Street 1:36 WASHINGTON ST
Practice Address - Street 2:SUITE 190
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1900
Practice Address - Country:US
Practice Address - Phone:508-726-9541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based