1114912003 NPI number — FAMILY HOSPICE AND PALLIATIVE CARE

Table of content: (NPI 1114912003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114912003 NPI number — FAMILY HOSPICE AND PALLIATIVE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HOSPICE AND PALLIATIVE CARE
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:
1114912003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 N. HERMITAGE ROAD
Provider Second Line Business Mailing Address:
COLONIAL SQUARE BUILDING 1, SUITE 5
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16148-3250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-983-6020
Provider Business Mailing Address Fax Number:
412-572-8826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N. HERMITAGE ROAD
Provider Second Line Business Practice Location Address:
COLONIAL SQUARE BUILDING 1, SUITE 5
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-983-6020
Provider Business Practice Location Address Fax Number:
412-572-8826
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
IVANKO
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
412-572-8811

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  0133HSP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 155899 , 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: 100776420 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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