Provider Demographics
NPI:1932434040
Name:THE COMMUNITY HOSPICE, INC
Entity type:Organization
Organization Name:THE COMMUNITY HOSPICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAZZACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-724-0284
Mailing Address - Street 1:445 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3809
Mailing Address - Country:US
Mailing Address - Phone:518-724-0200
Mailing Address - Fax:518-724-0299
Practice Address - Street 1:445 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-724-0200
Practice Address - Fax:518-724-0299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COMMUNITY HOSPICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-07
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03816199Medicaid