Provider Demographics
NPI:1710968151
Name:SPECIAL CARE HOSPICE LLC
Entity Type:Organization
Organization Name:SPECIAL CARE HOSPICE LLC
Other - Org Name:LIFE CHOICE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KOSMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-557-7300
Mailing Address - Street 1:437 PENNSYLVANIA AVE
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3414
Mailing Address - Country:US
Mailing Address - Phone:215-557-7300
Mailing Address - Fax:215-893-1740
Practice Address - Street 1:437 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3414
Practice Address - Country:US
Practice Address - Phone:215-557-7300
Practice Address - Fax:215-893-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16481602251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008906300001Medicaid
391649Medicare ID - Type Unspecified