MEDICARE: COMMUNITY HOSPICE OF N.E. FLORIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	5024096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134126774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOSPICE OF N.E. FLORIDA

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

Provider Business Practice Location Address
First Line	:	4266 SUNBEAM RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6030
Country	:	US
Telephone Number	:	904-268-5200
Fax Number	:	904-596-6200

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. PHILLIP C WARD
Credential	:
Telephone Number	:	904-268-5200

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/03/2024

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