Healthcare Provider Details

I. General information

NPI: 1932393717
Provider Name (Legal Business Name): COMMUNITY HOSPICE OF NORTHEAST FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 SUNBEAM RD
JACKSONVILLE FL
32257-6030
US

IV. Provider business mailing address

4266 SUNBEAM RD
JACKSONVILLE FL
32257-6030
US

V. Phone/Fax

Practice location:
  • Phone: 904-407-6231
  • Fax: 904-407-6033
Mailing address:
  • Phone: 904-407-6231
  • Fax: 904-407-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP C WARD
Title or Position: PRESIDENT & CEO
Credential:
Phone: 904-268-5200