Provider Demographics
NPI:1902181944
Name:HOSPICE OF MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:HOSPICE OF MASSACHUSETTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-493-6745
Mailing Address - Street 1:50 N LAURA ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3664
Mailing Address - Country:US
Mailing Address - Phone:904-493-6745
Mailing Address - Fax:
Practice Address - Street 1:50 N LAURA ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3664
Practice Address - Country:US
Practice Address - Phone:904-493-6745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based