Provider Demographics
NPI:1477652113
Name:NIAGARA HOSPICE, INC.
Entity Type:Organization
Organization Name:NIAGARA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LOMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-439-4417
Mailing Address - Street 1:4675 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1231
Mailing Address - Country:US
Mailing Address - Phone:716-439-4417
Mailing Address - Fax:716-439-6035
Practice Address - Street 1:4675 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1231
Practice Address - Country:US
Practice Address - Phone:716-439-4417
Practice Address - Fax:716-439-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3101501F251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01078477Medicaid
NY01078477Medicaid