MEDICARE: CONSTELLATION HOSPICE VA N LLC

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

General Provider Information

NPI Number	:	1003633942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSTELLATION HOSPICE VA N LLC

Provider Business Mailing Address
First Line	:	14 WESTPORT AVE
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-3915
Country	:	US
Telephone Number	:	804-750-4214
Fax Number	:	888-464-1264

Provider Business Practice Location Address
First Line	:	2760 EISENHOWER AVE STE 260
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4572
Country	:	US
Telephone Number	:	703-405-8814
Fax Number	:	888-339-4585

Authorized Official
Title or Position	:	CEO/AUTHORIZED OFFICIAL
Name	:	YITZCHOK STEG
Credential	:
Telephone Number	:	888-895-7695

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	03/24/2025

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