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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS262251E00000X
WA000031251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3300316Medicaid
WA9040528Medicaid
WA3990033Medicaid
OR090779Medicaid
WA131933Medicaid
WA9006057Medicaid
WA9040650Medicaid
WA501504Medicare ID - Type UnspecifiedHOSPICE FACILITY
WA131933Medicaid
WA500140Medicare Oscar/Certification