Healthcare Provider Details

I. General information

NPI: 1861989998
Provider Name (Legal Business Name): COMFORT 1 HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 04/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S DIXIE WAY STE B
SOUTH BEND IN
46637-3392
US

IV. Provider business mailing address

129 S DIXIE WAY STE B
SOUTH BEND IN
46637-3392
US

V. Phone/Fax

Practice location:
  • Phone: 574-387-4117
  • Fax:
Mailing address:
  • Phone: 574-387-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL CHIMUTU
Title or Position: ADMINISTRATOR
Credential:
Phone: 574-387-4117