Provider Demographics
NPI:1063498541
Name:HOSPICE OF THE SACRED HEART
Entity Type:Organization
Organization Name:HOSPICE OF THE SACRED HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDI
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CHPN
Authorized Official - Phone:570-706-2400
Mailing Address - Street 1:600 BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7901
Mailing Address - Country:US
Mailing Address - Phone:570-706-2400
Mailing Address - Fax:570-970-9717
Practice Address - Street 1:53 GLENMAURA NATIONAL BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-2160
Practice Address - Country:US
Practice Address - Phone:570-706-2400
Practice Address - Fax:570-970-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16561601251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011014860001Medicaid
PA1011014860001Medicaid