Provider Demographics
NPI:1386647915
Name:COMPASSIONATE CARE HOSPICE OF NORTHWESTERN PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE HOSPICE OF NORTHWESTERN PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:I
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-267-1178
Mailing Address - Street 1:261 CONNECTICUT DR
Mailing Address - Street 2:STE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4177
Mailing Address - Country:US
Mailing Address - Phone:609-267-1178
Mailing Address - Fax:609-267-3499
Practice Address - Street 1:429 S MAIN ST
Practice Address - Street 2:STE 10
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1684
Practice Address - Country:US
Practice Address - Phone:570-346-2241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012437950001Medicaid
PA391667Medicare Oscar/Certification