Healthcare Provider Details

I. General information

NPI: 1043326531
Provider Name (Legal Business Name): COMMUNITY HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 SPYRES WAY
MODESTO CA
95356-9256
US

IV. Provider business mailing address

4368 SPYRES WAY
MODESTO CA
95356-9259
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-6320
  • Fax: 209-541-3280
Mailing address:
  • Phone: 209-578-6300
  • Fax: 209-541-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARLOTTE DESHA MCLEOD
Title or Position: PRESIDENT/CEO
Credential:
Phone: 209-578-6300