Healthcare Provider Details

I. General information

NPI: 1891736336
Provider Name (Legal Business Name): COMMUNITY HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 S GLENBURNIE RD SUITE A
NEW BERN NC
28562-2603
US

IV. Provider business mailing address

655 BRAWLEY SCHOOL RD SUITE 200
MOORESVILLE NC
28117-9125
US

V. Phone/Fax

Practice location:
  • Phone: 252-672-8301
  • Fax: 855-250-9588
Mailing address:
  • Phone: 704-664-2876
  • Fax: 704-664-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHOS2302/HC3439
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3401586
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: JANET COMBS
Title or Position: VP, LICENSURE
Credential:
Phone: 913-814-2013