MEDICARE: SPECIAL CARE 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	16481602	PA

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

General Provider Information

NPI Number	:	1710968151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL CARE HOSPICE LLC

Provider Business Mailing Address
First Line	:	437 PENNSYLVANIA AVE
Second Line	:	PO BOX 249
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3414
Country	:	US
Telephone Number	:	215-557-7300
Fax Number	:	215-893-1740

Provider Business Practice Location Address
First Line	:	437 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3414
Country	:	US
Telephone Number	:	215-557-7300
Fax Number	:	215-893-1740

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MILES DOUGLAS KOSMIN
Credential	:
Telephone Number	:	215-557-7300

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	08/22/2020

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