COMFORTBROOK HOSPICE LLC NPI 1649482621

NPI Information

NPI: 1649482621
Provider Name: COMFORTBROOK HOSPICE, LLC

Doing Business As: GRACE HOSPICE

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

CLIA Number: 36D2064827

Address:
1900 INDIAN WOOD CIR STE 202A
MAUMEE, OH
ZIP 43537
Phone: (567) 218-2075
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COMFORTBROOK HOSPICE, LLC is a hospice care community based in Maumee, OH. COMFORTBROOK HOSPICE, LLC NPI is 1649482621. The provider is registered as an organization entity type.
The provider Is Doing Business As Grace Hospice.

The provider's business location address is:

1900 INDIAN WOOD CIR STE 202A
MAUMEE, OH
ZIP 43537-039
Phone: (567) 218-2075
Fax: (877) 473-8167

The provider's authorized official is Matthew Chance .
The authorized official title is Ceo/authorized Official and has the following contact phone number (248) 824-6004.

The CLIA number assigned to this NPI record is 36D2064827 - hospice with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/4/2007 and was last updated on 5/27/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251G00000X	Hospice Care, Community Based				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0193HSP	OTHER	OHIO	STATE OF OHIO HOSPICE LICENSE
2	2889674	MEDICAID	OHIO
3	FCY.022229050-12	OTHER	OHIO	OH TDDD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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