{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CONCORDIA HOSPICE OF WASHINGTON",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10 LEET ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WASHINGTON",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15301-3382",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-250-4500",
"MailingAddressFaxNumber": "724-250-4558",
"FirstLinePracticeLocationAddress": "10 LEET ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WASHINGTON",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-250-4500",
"PracticeLocationAddressFaxNumber": "724-250-4558",
"EnumerationDate": "09/08/2006",
"LastUpdateDate": "09/12/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOUISE",
"AuthorizedOfficialFirstName": "MENA",
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"AuthorizedOfficialTitle": "ADMINISTRATOR/EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "247-250-4500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "315D00000X",
"TaxonomyName": "Inpatient Hospice",
"LicenseNumber": "151999",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}