Provider Demographics
NPI:1629016670
Name:ASERACARE HOSPICE - PHILADELPHIA, LLC
Entity Type:Organization
Organization Name:ASERACARE HOSPICE - PHILADELPHIA, LLC
Other - Org Name:ASERACARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASMUSSEN-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4840
Mailing Address - Street 1:250 CANAL PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-8927
Mailing Address - Country:US
Mailing Address - Phone:901-758-1450
Mailing Address - Fax:
Practice Address - Street 1:250 CANAL PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-8927
Practice Address - Country:US
Practice Address - Phone:901-758-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
000070096OtherBCBS
MS03459891Medicaid
000070096OtherBCBS
MS251556Medicare Oscar/Certification