Provider Demographics
NPI:1841384765
Name:INTERIM HEALTHCARE OF PITTSBURGH
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF PITTSBURGH
Other - Org Name:INTERIM HEALTHCARE OF BRIDGEPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-436-9404
Mailing Address - Street 1:37 GRANDE MEADOWS DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9035
Mailing Address - Country:US
Mailing Address - Phone:304-592-3538
Mailing Address - Fax:304-592-0817
Practice Address - Street 1:37 GRANDE MEADOWS DR STE 203
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9035
Practice Address - Country:US
Practice Address - Phone:304-592-3538
Practice Address - Fax:304-592-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV022134251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV51Q7098001Medicare ID - Type Unspecified