1992780670 NPI number — KEYSTONE HOSPICE

Table of content: (NPI 1992780670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992780670 NPI number — KEYSTONE HOSPICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE HOSPICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992780670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8765 STENTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYNDMOOR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19038-8317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-836-2440
Provider Business Mailing Address Fax Number:
215-836-3470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8765 STENTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYNDMOOR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19038-8317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-836-2440
Provider Business Practice Location Address Fax Number:
215-836-3470
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
INDERWIES
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
215-836-2440

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  159399 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001985000 . This is a "FEDERAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1064424 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 391593 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 14622 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001985000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 159399 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001985000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: X000363701 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001985000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 561447 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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