Provider Demographics
NPI:1588631733
Name:THE COMMUNITY HOSPICE INC
Entity Type:Organization
Organization Name:THE COMMUNITY HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAZZACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-724-0200
Mailing Address - Street 1:445 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3809
Mailing Address - Country:US
Mailing Address - Phone:518-724-0200
Mailing Address - Fax:518-724-0299
Practice Address - Street 1:445 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-724-0200
Practice Address - Fax:518-724-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4152500F251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00955739Medicaid
NY00955739Medicaid