Provider Demographics
NPI:1770585143
Name:COMFORT HOSPICE CARE, LLC
Entity type:Organization
Organization Name:COMFORT HOSPICE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-522-2902
Mailing Address - Street 1:PO BOX 1365
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6365
Mailing Address - Country:US
Mailing Address - Phone:801-547-0812
Mailing Address - Fax:801-547-0818
Practice Address - Street 1:124 S FAIRFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7105
Practice Address - Country:US
Practice Address - Phone:801-547-0812
Practice Address - Fax:801-547-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSPICE-48704251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461532Medicare ID - Type UnspecifiedHOSPICE PROVIDER NUMBER