Provider Demographics
NPI:1508906694
Name:COMMUNITY HOSPICE CARE
Entity Type:Organization
Organization Name:COMMUNITY HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:419-447-4040
Mailing Address - Street 1:181 E PERRY ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2312
Mailing Address - Country:US
Mailing Address - Phone:419-447-4040
Mailing Address - Fax:419-447-4657
Practice Address - Street 1:181 E PERRY ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2312
Practice Address - Country:US
Practice Address - Phone:419-447-4040
Practice Address - Fax:419-447-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0040HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0040HSPOtherHOSPICE LICENSE
OH0820151Medicaid
OH0820151Medicaid