MEDICARE: COMMONWEALTH 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	:	1336783323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH HOSPICE LLC

Provider Business Mailing Address
First Line	:	4955 STEUBENVILLE PIKE STE 125
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-9699
Country	:	US
Telephone Number	:	412-489-5893
Fax Number	:	412-489-5891

Provider Business Practice Location Address
First Line	:	4955 STEUBENVILLE PIKE STE 125
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-9699
Country	:	US
Telephone Number	:	412-489-5893
Fax Number	:	412-489-5891

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHRISTIAN VAGLEY
Credential	:
Telephone Number	:	412-889-8741

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	10/06/2020

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Directions to “COMMONWEALTH HOSPICE LLC ” Practice Location

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