Provider Demographics
NPI:1023010329
Name:TRADITIONAL HOME HEALTH AND HOSPICE LLC
Entity Type:Organization
Organization Name:TRADITIONAL HOME HEALTH AND HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-207-9286
Mailing Address - Street 1:113 W DRINKER ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1913
Mailing Address - Country:US
Mailing Address - Phone:570-207-9286
Mailing Address - Fax:
Practice Address - Street 1:113 W DRINKER ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1913
Practice Address - Country:US
Practice Address - Phone:570-207-9286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA77740501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA817359OtherBLUE CROSS PROVIDER NUMBE
PA0019095000003Medicaid
PA83241OtherGEISINGER PROVIDER NUMBER
PA397774Medicare Oscar/Certification