Provider Demographics
NPI:1790923019
Name:INTERIM HEALTHCARE HOSPICE OF WESTERN PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE HOSPICE OF WESTERN PENNSYLVANIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-436-9404
Mailing Address - Street 1:1789 SOUTH BRADDOCK AVENUE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218
Mailing Address - Country:US
Mailing Address - Phone:412-371-3726
Mailing Address - Fax:412-243-4313
Practice Address - Street 1:1789 SOUTH BRADDOCK AVENUE
Practice Address - Street 2:SUITE 340
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218
Practice Address - Country:US
Practice Address - Phone:412-371-3726
Practice Address - Fax:412-243-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023802600001Medicaid
PA002151439OtherHIGHMARK
PA002151439OtherHIGHMARK