Provider Demographics
NPI:1962407486
Name:COMMUNITY HOSPICE, INC.
Entity type:Organization
Organization Name:COMMUNITY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LESONDAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-522-4244
Mailing Address - Street 1:32932 WARREN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3095
Mailing Address - Country:US
Mailing Address - Phone:734-522-4244
Mailing Address - Fax:734-522-2099
Practice Address - Street 1:32932 WARREN RD
Practice Address - Street 2:STE 100
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3095
Practice Address - Country:US
Practice Address - Phone:734-522-4244
Practice Address - Fax:734-522-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI823511251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1791750Medicaid
MI08706OtherBLUE CROSS PROVID #
MI1791750Medicaid