Provider Demographics
NPI:1649482621
Name:COMFORTBROOK HOSPICE, LLC
Entity type:Organization
Organization Name:COMFORTBROOK HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-824-6004
Mailing Address - Street 1:P.O. BOX 99278
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9278
Mailing Address - Country:US
Mailing Address - Phone:248-824-6609
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:1900 INDIAN WOOD CIR STE 202A
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4039
Practice Address - Country:US
Practice Address - Phone:567-218-2075
Practice Address - Fax:877-473-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193HSPOtherSTATE OF OHIO HOSPICE LICENSE
OH2889674Medicaid
OHFCY.022229050-12OtherOH TDDD