Provider Demographics
NPI:1144604281
Name:MAIN LINE HEALTH HOMECARE AND HOSPICE
Entity Type:Organization
Organization Name:MAIN LINE HEALTH HOMECARE AND HOSPICE
Other - Org Name:MAIN LINE HEALTH HOMECARE AND HOSPICE - HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BSN, CHPCA, CHP
Authorized Official - Phone:484-580-1400
Mailing Address - Street 1:240 N RADNOR CHESTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5170
Mailing Address - Country:US
Mailing Address - Phone:484-580-1400
Mailing Address - Fax:484-580-1414
Practice Address - Street 1:240 N RADNOR CHESTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5170
Practice Address - Country:US
Practice Address - Phone:484-580-1400
Practice Address - Fax:484-580-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39-7012A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007537580006Medicaid
PA397012AMedicare Oscar/Certification