Provider Demographics
NPI:1437169943
Name:PAX CHRISTI HOSPICE, INC.
Entity Type:Organization
Organization Name:PAX CHRISTI HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA
Authorized Official - Phone:718-876-1022
Mailing Address - Street 1:1200 SOUTH AVE
Mailing Address - Street 2:SUIT 306
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3413
Mailing Address - Country:US
Mailing Address - Phone:718-876-1022
Mailing Address - Fax:718-876-1803
Practice Address - Street 1:1200 SOUTH AVE
Practice Address - Street 2:SUIT 306
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3413
Practice Address - Country:US
Practice Address - Phone:718-876-1022
Practice Address - Fax:718-876-1803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT'S CATHOLIC MEDICAL CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01105884Medicaid
NY01105884Medicaid