Basic Information
| Provider Information | |||||||||
| NPI: | 1013292051 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE OF PENNSYLVANIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 N LAURA ST | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322023664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044936745 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1653 THE FAIRWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | JENKINTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190461420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044936745 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2011 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | FOGLE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9044936745 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.