Active NPI
Community Hospice, Inc.
- Community Based Hospice Care Agency
- Modesto, CA
National Provider Identifier
1043326531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- COMMUNITY HOSPICE, INC.
- Practice address
- 4368 Spyres Way
Modesto, CA 95356-9256 - Phone
- (209) 578-6320
- Fax
- (209) 541-3280
- NPI assigned
- Aug 21, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Charlotte Desha McLeod
- Title
- President/Ceo
- Phone
- (209) 578-6300
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
4368 Spyres Way
Modesto, CA 95356-9256
Mailing address
4368 Spyres Way
Modesto, CA 95356-9259
Phone (209) 578-6300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8PCO543F | Medicaid | CA | |
| HPC01543F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061101000295 | CA | Part A Provider - Hospice | 7517964729 | Practice locations: Hughson, CA; Modesto, CA; Stockton, CA |
| O20120530000205 | CA | Part B Supplier - Clinic/Group Practice | 7517964729 |
Receives reassigned benefits from 3 practitioners Practice locations: Modesto, CA |
Hospice certification: CCN 051543
- Legal name
- COMMUNITY HOSPICE, INC.
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 18, 1988
- Last certification
- Jun 7, 2019
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Corporation
- Incorporated
- Nov 29, 1979 in CA
- Enrollment address
- 4368 Spyres Way
Modesto, CA 95356-9259
Care Compare: Hospice
Medicare Care Compare- Listed as
- Community Hospice, Inc - Hospice
- Ownership
- Non-Profit
- Certified
- Aug 18, 1988
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Community Hospice Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Counselor
- Modesto, CA
- NPI 1912661893
Locations
2201 Euclid Ave
Hughson, CA 95326
Ownership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Karryn Salonen | Corporate Officer | Apr 16, 2018 | |
| W-2 Managing Employee | Apr 16, 2018 | ||
| Susan Hudgeons | Corporate Director | Jan 1, 2018 | |
| Susan Donker | Corporate Director | Jan 1, 2018 | |
| Jennifer Dunn | W-2 Managing Employee | Apr 23, 2008 | |
| Laurence Huntington Martin | Corporate Director | Jan 1, 2012 | |
| Tom Van Groningen | Corporate Director | Jan 1, 2018 | |
| Tami J Bennett | Corporate Officer | Sep 1, 2005 | |
| James Grothe | Corporate Director | Jul 1, 2011 | |
| Charlotte Desha McLeod | Corporate Officer | Jul 1, 2013 | |
| Corporate Director | Jul 1, 2013 | ||
| W-2 Managing Employee | Jul 1, 2013 | 100% | |
| Operational/Managerial Control | Jul 1, 2013 | 100% |
Practitioners & affiliated clinicians
Practitioners 14
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- MOHS-Micrographic Surgery Physician
- Ukiah, CA
- NPI 1023252350
-
- Family Nurse Practitioner
- Stockton, CA
- NPI 1558639716
Single Specialty
-
- Physician Assistant
- Manteca, CA
- NPI 1457133738
-
- Dermatology Physician
- Sacramento, CA
- NPI 1477818938
-
- Plastic and Reconstructive Surgery Physician
- Santa Rosa, CA
- NPI 1235175902
-
- Dermatology Physician
- Porterville, CA
- NPI 1649229154
-
- Dermatology Physician
- Manteca, CA
- NPI 1457456584
-
- Physician Assistant
- Stockton, CA
- NPI 1962182030
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1478563200000",
"number": "1043326531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4368 SPYRES WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569259",
"telephone_number": "209-578-6300",
"fax_number": "209-541-3280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4368 SPYRES WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569256",
"telephone_number": "209-578-6320",
"fax_number": "209-541-3280"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY HOSPICE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-21",
"last_updated": "2016-11-08",
"status": "A",
"authorized_official_last_name": "MCLEOD",
"authorized_official_first_name": "CHARLOTTE",
"authorized_official_middle_name": "DESHA",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "209-578-6300",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8PCO543F",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HPC01543F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.