Provider Demographics
NPI:1497445522
Name:COMMUNITY CARE HOSPICE INC
Entity Type:Organization
Organization Name:COMMUNITY CARE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HRANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISH GHUKASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-606-3632
Mailing Address - Street 1:151 N 3RD AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 N 3RD AVE STE 202A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6368
Practice Address - Country:US
Practice Address - Phone:206-606-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based