Basic Information
| Provider Information | |||||||||
| NPI: | 1710926159 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMFORT CARE HOSPICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMFORT CARE HOSPICE OF MONTGOMERY | ||||||||
| 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 | ||||||||
| FaxNumber: | 8882693065 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 SAINT LUKES DR | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361177109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345140244 | ||||||||
| FaxNumber: | 3345140241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SPEER | ||||||||
| AuthorizedOfficialFirstName: | KATE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AVP | ||||||||
| AuthorizedOfficialTelephone: | 4704648000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | N | Agencies | Hospice Care, Community Based | 251G00000X | 11673 | AL | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 105143 | 05 | AL | MEDICAID |