Provider Demographics
NPI:1376750398
Name:365 HOSPICE, LLC
Entity Type:Organization
Organization Name:365 HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-946-5017
Mailing Address - Street 1:119 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-0477
Mailing Address - Country:US
Mailing Address - Phone:814-419-4901
Mailing Address - Fax:814-419-4902
Practice Address - Street 1:220 REGENT CT STE E2
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7969
Practice Address - Country:US
Practice Address - Phone:814-946-5017
Practice Address - Fax:814-308-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16911601OtherSTATE OF PENNSYLVANIA
PA1020513330001Medicaid
391691Medicare Oscar/Certification