1801990122 NPI number — CONCORDIA HOSPICE OF WASHINGTON

Table of content: (NPI 1801990122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801990122 NPI number — CONCORDIA HOSPICE OF WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCORDIA HOSPICE OF WASHINGTON
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:
1801990122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 LEET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-250-4500
Provider Business Mailing Address Fax Number:
724-250-4558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 LEET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-250-4500
Provider Business Practice Location Address Fax Number:
724-250-4558
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUISE
Authorized Official First Name:
MENA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
247-250-4500

Provider Taxonomy Codes

  • Taxonomy code: 315D00000X , with the licence number:  151999 , 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: 1031493900001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1570853 . This is a "MEDICAID - GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 65496 . This is a "MEDICAID - UHC COMMUNITY PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 202269 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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