MEDICARE: 1 LAUREL HIGHLANDS HOSPICE, 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	:	1235990169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 LAUREL HIGHLANDS HOSPICE, LLC

Provider Business Mailing Address
First Line	:	970 FRANKLIN ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4107
Country	:	US
Telephone Number	:	814-248-3004
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 FRANKLIN ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4107
Country	:	US
Telephone Number	:	814-410-9119
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRYSTAL M CHASON
Credential	:
Telephone Number	:	814-410-9119

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	04/26/2024

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