Provider Demographics
NPI:1851706873
Name:GRANE HOSPICE CARE, INC.
Entity type:Organization
Organization Name:GRANE HOSPICE CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-828-2210
Mailing Address - Street 1:1012 W 9TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1093
Mailing Address - Country:US
Mailing Address - Phone:610-337-1721
Mailing Address - Fax:610-265-1685
Practice Address - Street 1:1012 W 9TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1093
Practice Address - Country:US
Practice Address - Phone:610-337-1721
Practice Address - Fax:610-265-1685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANE HOSPICE CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-28
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17651601251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101528721-0008Medicaid
PA101528721-0008Medicaid