Basic Information
| Provider Information | |||||||||
| NPI: | 1639550155 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HERITAGE HOSPICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HERITAGE HOSPICE NORTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 FAULCONER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229035089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349779711 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 W HIGH ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | EBENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159311706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243346600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2015 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 4349779711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 17617601 | PA | Y | Agencies | Hospice Care, Community Based |
No ID Information.