Provider Demographics
NPI:1417210980
Name:INTERIM HEALTHCARE HOSPICE OF WESTERN PENNSYLVANIA INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE HOSPICE OF WESTERN PENNSYLVANIA INC
Other - Org Name:INTERIM HEALTHCARE HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-436-9404
Mailing Address - Street 1:322 WARREN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3443
Mailing Address - Country:US
Mailing Address - Phone:814-262-8305
Mailing Address - Fax:814-254-1236
Practice Address - Street 1:322 WARREN ST
Practice Address - Street 2:SUITE 270
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3443
Practice Address - Country:US
Practice Address - Phone:814-262-8305
Practice Address - Fax:814-254-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391756Medicare UPIN