Basic Information
| Provider Information | |||||||||
| NPI: | 1104881366 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMFORT CARE HOSPICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMFORT CARE HOSPICE OF DEMOPOLIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2455 CAHABA VALLEY PARKWAY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059426820 | ||||||||
| FaxNumber: | 8882693065 | ||||||||
| Practice Location | |||||||||
| Address1: | 547 US HIGHWAY 80 W STE 2 | ||||||||
| Address2: | |||||||||
| City: | DEMOPOLIS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367324126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342892106 | ||||||||
| FaxNumber: | 3342892693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | AFSHAR | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4704648000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 10245 | AL | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | PIC1576E | 05 | AL | MEDICAID |