1134126774 NPI number — COMMUNITY HOSPICE OF N.E. FLORIDA

Table of content: (NPI 1134126774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134126774 NPI number — COMMUNITY HOSPICE OF N.E. FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HOSPICE OF N.E. FLORIDA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134126774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4266 SUNBEAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32257-6030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-268-5200
Provider Business Mailing Address Fax Number:
904-596-6200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4266 SUNBEAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32257-6030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-268-5200
Provider Business Practice Location Address Fax Number:
904-596-6200
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
904-268-5200

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  5024096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 087407800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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