Provider Demographics
NPI:1801990122
Name:CONCORDIA HOSPICE OF WASHINGTON
Entity type:Organization
Organization Name:CONCORDIA HOSPICE OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:247-250-4500
Mailing Address - Street 1:10 LEET ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3382
Mailing Address - Country:US
Mailing Address - Phone:724-250-4500
Mailing Address - Fax:724-250-4558
Practice Address - Street 1:10 LEET ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3382
Practice Address - Country:US
Practice Address - Phone:724-250-4500
Practice Address - Fax:724-250-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA151999315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031493900001Medicaid
PA1570853OtherMEDICAID - GATEWAY
PA65496OtherMEDICAID - UHC COMMUNITY PLAN
PA202269OtherUPMC
PA1570853OtherMEDICAID - GATEWAY
PA391519AMedicare Oscar/Certification