Provider Demographics
NPI:1992700074
Name:HOME CARE HOSPICE
Entity type:Organization
Organization Name:HOME CARE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-552-9980
Mailing Address - Street 1:2801 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1007
Mailing Address - Country:US
Mailing Address - Phone:215-552-9980
Mailing Address - Fax:215-552-9981
Practice Address - Street 1:2801 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1007
Practice Address - Country:US
Practice Address - Phone:215-552-9980
Practice Address - Fax:215-552-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA391635251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391635Medicare ID - Type UnspecifiedHOSPICE