Provider Demographics
NPI:1891736336
Name:COMMUNITY HOSPICE, LLC
Entity Type:Organization
Organization Name:COMMUNITY HOSPICE, LLC
Other - Org Name:COMMUNITY HOME CARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, LICENSURE
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-2013
Mailing Address - Street 1:655 BRAWLEY SCHOOL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9125
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:704-664-1306
Practice Address - Street 1:1423 S GLENBURNIE RD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2603
Practice Address - Country:US
Practice Address - Phone:252-672-8301
Practice Address - Fax:855-250-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
NCHOS2302/HC3439251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401586Medicaid
NC341586Medicare PIN