Provider Demographics
NPI:1851394571
Name:POCONO VNA-HOSPICE
Entity Type:Organization
Organization Name:POCONO VNA-HOSPICE
Other - Org Name:VISITING NURSE ASSOCIATION HOSPICE OF MONROE COU
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-421-5390
Mailing Address - Street 1:502 VNA ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7965
Mailing Address - Country:US
Mailing Address - Phone:570-421-5390
Mailing Address - Fax:570-421-7423
Practice Address - Street 1:502 VNA ROAD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7965
Practice Address - Country:US
Practice Address - Phone:570-421-5390
Practice Address - Fax:570-421-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA703105251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007095050003Medicaid
PA703105Medicaid
PA90454OtherTHREE RIVERS HOME HEALTH
PA703105Medicaid