Healthcare Provider Details

I. General information

NPI: 1932434040
Provider Name (Legal Business Name): THE COMMUNITY HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 NEW KARNER RD
ALBANY NY
12205
US

IV. Provider business mailing address

445 NEW KARNER RD
ALBANY NY
12205-3809
US

V. Phone/Fax

Practice location:
  • Phone: 518-724-0200
  • Fax: 518-724-0299
Mailing address:
  • Phone: 518-724-0200
  • Fax: 518-724-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELLE T MAZZACCO
Title or Position: VICE PRESIDENT
Credential:
Phone: 518-724-0284