MEDICARE: HOSPICE OF THE WESTERN RESERVE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	0003-HSP	OH
2	2080H0002X	Pediatric Hospice and Palliative Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0003-HSP	OTHER	OH	HOSPICE LICENSE

General Provider Information

NPI Number	:	1255333753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF THE WESTERN RESERVE, INC.

Provider Business Mailing Address
First Line	:	17876 SAINT CLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-2602
Country	:	US
Telephone Number	:	216-383-2222
Fax Number	:	216-298-0241

Provider Business Practice Location Address
First Line	:	300 E 185TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119
Country	:	US
Telephone Number	:	216-383-2222
Fax Number	:	216-383-3750

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. WILLIAM FINN
Credential	:	CEO
Telephone Number	:	216-383-2222

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/21/2018

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