Healthcare Provider Details

I. General information

NPI: 1770583908
Provider Name (Legal Business Name): BETHANY HOSPICE SERVICES OF WESTERN PENNSYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GREENTREE RD STE 100 SIX PARKWAY CENTER
PITTSBURGH PA
15220-3508
US

IV. Provider business mailing address

875 GREENTREE RD STE 100 SIX PARKWAY CENTER
PITTSBURGH PA
15220-3508
US

V. Phone/Fax

Practice location:
  • Phone: 412-921-2209
  • Fax: 412-921-2552
Mailing address:
  • Phone: 412-921-2209
  • Fax: 412-921-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number16641601
License Number StatePA

VIII. Authorized Official

Name: MS. DIANE L MEAD
Title or Position: PRESIDENT
Credential: RN, BSN
Phone: 412-921-2209