Provider Demographics
NPI:1467974907
Name:SIGNATURE HOSPICE CARE LLC
Entity Type:Organization
Organization Name:SIGNATURE HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-557-7486
Mailing Address - Street 1:66 N RTE 17, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2742
Mailing Address - Country:US
Mailing Address - Phone:201-956-7896
Mailing Address - Fax:
Practice Address - Street 1:66 N RTE 17 STE 2
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2742
Practice Address - Country:US
Practice Address - Phone:201-956-7896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based