Provider Demographics
NPI:1386641629
Name:HERNANDO-PASCO HOSPICE, INC.
Entity type:Organization
Organization Name:HERNANDO-PASCO HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, LEGAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:813-871-8075
Mailing Address - Street 1:12470 TELECOM DR STE 301
Mailing Address - Street 2:ATTENTION: COMPLIANCE
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0904
Mailing Address - Country:US
Mailing Address - Phone:813-871-8075
Mailing Address - Fax:
Practice Address - Street 1:12260 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-2626
Practice Address - Country:US
Practice Address - Phone:866-940-0962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5008096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014043700Medicaid
FLU26OtherBLUE CROSS - HOSPICE
FL0998066OtherAETNA
FL0779226OtherCIGNA
FL6001156OtherUNITED HEALTHCARE
FL014043700Medicaid
FL087515500Medicaid