Provider Demographics
NPI:1821590670
Name:VITRA HOSPICE LLC
Entity Type:Organization
Organization Name:VITRA HOSPICE LLC
Other - Org Name:VITRA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPIVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-297-2022
Mailing Address - Street 1:150 WOOD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2510
Mailing Address - Country:US
Mailing Address - Phone:508-297-2022
Mailing Address - Fax:
Practice Address - Street 1:150 WOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2510
Practice Address - Country:US
Practice Address - Phone:508-297-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based