Provider Demographics
NPI:1992780670
Name:KEYSTONE HOSPICE
Entity type:Organization
Organization Name:KEYSTONE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:INDERWIES
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MBA
Authorized Official - Phone:215-836-2440
Mailing Address - Street 1:8765 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8317
Mailing Address - Country:US
Mailing Address - Phone:215-836-2440
Mailing Address - Fax:215-836-3470
Practice Address - Street 1:8765 STENTON AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-8317
Practice Address - Country:US
Practice Address - Phone:215-836-2440
Practice Address - Fax:215-836-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA159399251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001985000OtherFEDERAL BLUE CROSS
PA1064424OtherKEYSTONE MERCY
PA391593OtherTRICARE
PA14622OtherHEALTH PARTNERS
PA0001985000OtherPERSONAL CHOICE
PA159399Medicaid
PA0001985000OtherKEYSTONE HEALTH PLAN EAST
PAX000363701OtherAMERICHOICE
PA0001985000OtherINDEPENDENCE BLUE CROSS
PA561447OtherAETNA
PA159399Medicaid
PA0001985000OtherFEDERAL BLUE CROSS
PA=========OtherAMERIHEALTH ADMINISTRATOR