MEDICARE: CONSTELLATION HOSPICE OH, 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	:	1477307940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSTELLATION HOSPICE OH, LLC

Provider Business Mailing Address
First Line	:	14 WESTPORT AVE
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-3915
Country	:	US
Telephone Number	:	513-504-4987
Fax Number	:	888-453-0829

Provider Business Practice Location Address
First Line	:	1929 GREGORY LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1434
Country	:	US
Telephone Number	:	513-504-4987
Fax Number	:	888-453-0829

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

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	03/24/2025

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