Basic Information
| Provider Information | |||||||||
| NPI: | 1457716839 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | 365 HOSPICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | 365 HOME HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 477 | ||||||||
| Address2: | 119 S MAIN ST | ||||||||
| City: | CARROLLTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157220477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144194901 | ||||||||
| FaxNumber: | 8144194902 | ||||||||
| Practice Location | |||||||||
| Address1: | 2549 MOSSIDE BLVD | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123725320 | ||||||||
| FaxNumber: | 4123725926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2015 | ||||||||
| LastUpdateDate: | 12/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | REZK | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8144194901 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.