1376750398 NPI number — 365 HOSPICE, LLC

Table of content: (NPI 1376750398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376750398 NPI number — 365 HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
365 HOSPICE, 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:
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:
1376750398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15722-0477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-419-4901
Provider Business Mailing Address Fax Number:
814-419-4902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 W COLLEGE AVE STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-946-5017
Provider Business Practice Location Address Fax Number:
814-308-9947
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REZK
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
814-946-5017

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1020513330001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16911601 . This is a "STATE OF PENNSYLVANIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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