Basic Information
| Provider Information | |||||||||
| NPI: | 1285924209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMBASSY HOSPICE SERVICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24579 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441466338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404397976 | ||||||||
| FaxNumber: | 4402327113 | ||||||||
| Practice Location | |||||||||
| Address1: | 24579 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441466338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404397976 | ||||||||
| FaxNumber: | 4402327113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 04/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | HANDLER | ||||||||
| AuthorizedOfficialFirstName: | DARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3303175141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.