Provider Demographics
NPI:1336772581
Name:ASHLAR HOME HEALTH AND HOSPICE SERVICES LLC
Entity Type:Organization
Organization Name:ASHLAR HOME HEALTH AND HOSPICE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLGEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-367-1121
Mailing Address - Street 1:98 MASONIC DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2574
Mailing Address - Country:US
Mailing Address - Phone:717-361-4999
Mailing Address - Fax:717-361-5767
Practice Address - Street 1:98 MASONIC DR STE 101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2574
Practice Address - Country:US
Practice Address - Phone:717-361-4999
Practice Address - Fax:717-361-5767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035869490003Medicaid