Provider Demographics
NPI:1407859978
Name:COMPASSIONATE CARE HOSPICE OF GWYNEDD, INC.
Entity Type:Organization
Organization Name:COMPASSIONATE CARE HOSPICE OF GWYNEDD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:U
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3701
Mailing Address - Street 1:3854 AMERICAN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4897
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:3331 STREET RD
Practice Address - Street 2:ONE GREENWOOD SQUARE STE 410
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2052
Practice Address - Country:US
Practice Address - Phone:215-245-3525
Practice Address - Fax:215-245-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015491200004Medicaid
PA0015491200004Medicaid