MEDICARE: OPTUM PALLIATIVE AND HOSPICE CARE, 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	H1538	MD

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225081888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM PALLIATIVE AND HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	215-902-8241
Fax Number	:	215-902-8809

Provider Business Practice Location Address
First Line	:	6095 MARSHALEE DR
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6053
Country	:	US
Telephone Number	:	410-379-3599
Fax Number	:	866-950-6039

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JOHN O. ENDERLE
Credential	:
Telephone Number	:	860-221-0793

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/04/2015

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