Provider Demographics
NPI:1407412430
Name:COMFORT HOSPICE LLC
Entity type:Organization
Organization Name:COMFORT HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:REGINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-413-4952
Mailing Address - Street 1:PO BOX 44044
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1044
Mailing Address - Country:US
Mailing Address - Phone:952-492-9039
Mailing Address - Fax:844-829-7747
Practice Address - Street 1:6440 FLYING CLOUD DR STE 114
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3321
Practice Address - Country:US
Practice Address - Phone:952-884-1800
Practice Address - Fax:844-829-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1407412430Medicaid