MEDICARE: COMMUNITY HOSPICES OF AMERICA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	125-2HO	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023070984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOSPICES OF AMERICA, LLC

Provider Business Mailing Address
First Line	:	10 CADILLAC DR
Second Line	:	SUITE 400
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5078
Country	:	US
Telephone Number	:	615-425-5407
Fax Number	:	615-373-4457

Provider Business Practice Location Address
First Line	:	3405 W TRUMAN BLVD STE 210
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5861
Country	:	US
Telephone Number	:	573-556-3547
Fax Number	:	573-556-6597

Authorized Official
Title or Position	:	SVP GENERAL COUNSEL
Name	:	RUSSELL ADKINS
Credential	:
Telephone Number	:	615-309-5668

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	02/22/2022

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