MEDICARE: BETHANY HOSPICE SERVICES OF WESTERN PENNSYLVANIA, 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	16641601	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	:	1770583908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY HOSPICE SERVICES OF WESTERN PENNSYLVANIA, LLC

Provider Business Mailing Address
First Line	:	875 GREENTREE RD STE 100
Second Line	:	SIX PARKWAY CENTER
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-3508
Country	:	US
Telephone Number	:	412-921-2209
Fax Number	:	412-921-2552

Provider Business Practice Location Address
First Line	:	875 GREENTREE RD STE 100
Second Line	:	SIX PARKWAY CENTER
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-3508
Country	:	US
Telephone Number	:	412-921-2209
Fax Number	:	412-921-2552

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DIANE L MEAD
Credential	:	RN, BSN
Telephone Number	:	412-921-2209

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/16/2013

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