Healthcare Provider Details

I. General information

NPI: 1073714101
Provider Name (Legal Business Name): HOSPICE OF CHATTANOOGA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 HAMILTON PLACE BLVD STE 220
CHATTANOOGA TN
37421-6040
US

IV. Provider business mailing address

1234 CHESTNUT ST STE 114
NEWTON MA
02464-1491
US

V. Phone/Fax

Practice location:
  • Phone: 423-553-1823
  • Fax:
Mailing address:
  • Phone: 434-977-9711
  • Fax: 434-235-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSE R MOORE
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 857-331-6271