1003813718 NPI number — SEASONS HOSPICE & PALLIATIVE CARE OF MARYLAND, LLC

Table of content: (NPI 1003813718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003813718 NPI number — SEASONS HOSPICE & PALLIATIVE CARE OF MARYLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEASONS HOSPICE & PALLIATIVE CARE OF MARYLAND, LLC
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:
ACCENTCARE HOSPICE & PALLIATIVE CARE OF MARYLAND
Provider Other Organization Name Type Code:
3
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:
1003813718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 SHAFER CT
Provider Second Line Business Mailing Address:
STE 700
Provider Business Mailing Address City Name:
ROSEMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-4914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-759-9449
Provider Business Mailing Address Fax Number:
847-375-2148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5457 TWIN KNOLLS RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-523-6000
Provider Business Practice Location Address Fax Number:
410-277-4251
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SISCEL
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
VP LEGAL
Authorized Official Telephone Number:
224-221-0465

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  H1507 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 403379504 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 403394900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 403379501 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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