Provider Demographics
NPI:1497725949
Name:POCONO VNA-HOSPICE
Entity Type:Organization
Organization Name:POCONO VNA-HOSPICE
Other - Org Name:LEHIGH VALLEY HOSPICE POCONO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-421-5390
Mailing Address - Street 1:502 VNA ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7965
Mailing Address - Country:US
Mailing Address - Phone:570-421-5390
Mailing Address - Fax:570-421-7423
Practice Address - Street 1:502 VNA ROAD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7965
Practice Address - Country:US
Practice Address - Phone:570-421-5390
Practice Address - Fax:570-421-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152399251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007769950003Medicaid
PA152399Medicaid
PA1007769950003Medicaid