Healthcare Provider Details

I. General information

NPI: 1871573766
Provider Name (Legal Business Name): COMMUNITY HOME HEALTH HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 11TH AVE
LONGVIEW WA
98632-2505
US

IV. Provider business mailing address

PO BOX 2067
LONGVIEW WA
98632-8189
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-8510
  • Fax: 360-425-4667
Mailing address:
  • Phone: 360-425-8510
  • Fax: 360-425-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIS262
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number000031
License Number StateWA

VIII. Authorized Official

Name: MR. GREG PANG
Title or Position: EXECUTIVE DIRECTOR
Credential: MHA CHCE
Phone: 360-425-8510