Provider Demographics
NPI:1770583908
Name:BETHANY HOSPICE SERVICES OF WESTERN PENNSYLVANIA, LLC
Entity type:Organization
Organization Name:BETHANY HOSPICE SERVICES OF WESTERN PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:412-921-2209
Mailing Address - Street 1:875 GREENTREE RD STE 100
Mailing Address - Street 2:SIX PARKWAY CENTER
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3508
Mailing Address - Country:US
Mailing Address - Phone:412-921-2209
Mailing Address - Fax:412-921-2552
Practice Address - Street 1:875 GREENTREE RD STE 100
Practice Address - Street 2:SIX PARKWAY CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3508
Practice Address - Country:US
Practice Address - Phone:412-921-2209
Practice Address - Fax:412-921-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16641601251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012121800001Medicaid
PA1012121800001Medicaid