Basic Information
| Provider Information | |||||||||
| NPI: | 1780937649 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIFE CHOICE HOSPICE OF SOUTHERN MASSACHUSETTS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPASSUS - SOUTHERN MASSACHUSETTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CADILLAC DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153777022 | ||||||||
| FaxNumber: | 6153734457 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 TURNPIKE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | NORTH ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018456138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787778222 | ||||||||
| FaxNumber: | 9787778224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2012 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 6153095668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.