MEDICARE: TRI-STATE HOME 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	332B00000X	Durable Medical Equipment & Medical Supplies		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2120780	OTHER	PA	AETNA
2	67537	OTHER	PA	UNISON
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	205776	OTHER	PA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427123595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE HOME CARE INC.

Provider Business Mailing Address
First Line	:	149 GRANT AVE
Second Line	:
City	:	MILLVALE
State	:	PA
Zip	:	15209-2607
Country	:	US
Telephone Number	:	412-822-7801
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 GRANT AVE
Second Line	:
City	:	MILLVALE
State	:	PA
Zip	:	15209-2607
Country	:	US
Telephone Number	:	412-822-7801
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. WALTER ANTHONY PAWLOWSKI JR.
Credential	:
Telephone Number	:	412-822-7801

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/26/2022

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Directions to “TRI-STATE HOME CARE INC. ” Practice Location

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