Basic Information
| Provider Information | |||||||||
| NPI: | 1194730556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC | ||||||||
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| OtherOrganizationName: | CONEMAUGH REGIONAL HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 SEVEN SPRINGS WAY | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159207000 | ||||||||
| FaxNumber: | 6159208913 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 LOCUST ST | ||||||||
| Address2: | SUITE 5E | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159011651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145346100 | ||||||||
| FaxNumber: | 8145346105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 05/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | GIOVANETTI | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6159207000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 156599 | PA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | PO29291 | 01 | CHAMPUS | OTHER | 242848 | 01 | PA | UNISON | OTHER | 87 | 01 | PA | UPMC | OTHER | 001491870 | 05 | PA | MEDICAID | HIGHMARK - 1024 | 01 | PA | HOSPICE | OTHER | 0124863 | 01 | CIGNA | OTHER | GATEWAY - 1502289 | 01 | PA | HOSPICE | OTHER |