Provider Demographics
NPI:1871573766
Name:COMMUNITY HOME HEALTH HOSPICE
Entity type:Organization
Organization Name:COMMUNITY HOME HEALTH HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:MHA CHCE
Authorized Official - Phone:360-425-8510
Mailing Address - Street 1:PO BOX 2067
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8189
Mailing Address - Country:US
Mailing Address - Phone:360-425-8510
Mailing Address - Fax:360-425-4667
Practice Address - Street 1:1035 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2505
Practice Address - Country:US
Practice Address - Phone:360-425-8510
Practice Address - Fax:360-425-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS262251E00000X
WA000031251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3300316Medicaid
WA9040528Medicaid
WA3990033Medicaid
OR090779Medicaid
WA131933Medicaid
WA9006057Medicaid
WA9040650Medicaid
WA501504Medicare ID - Type UnspecifiedHOSPICE FACILITY
WA131933Medicaid
WA500140Medicare Oscar/Certification