Basic Information
| Provider Information | |||||||||
| NPI: | 1588697056 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMFORT CARE HOSPICE LLC | ||||||||
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| OtherOrganizationName: | COMFORT CARE HOSPICE OF MONROEVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 INTERSTATE NORTH PKWY SE STE 1600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303395047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4704648000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29 PINEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364601827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2512278880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | SPEER | ||||||||
| AuthorizedOfficialFirstName: | KATE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AVP | ||||||||
| AuthorizedOfficialTelephone: | 9523583278 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 11651 | AL | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | PIC1640E | 05 | AL | MEDICAID | 11651 | 01 | AL | LICENSE | OTHER |