NPIMap

Organization Active NPI

Traditional Home Health and Hospice LLC

  • Home Health Agency
  • Dunmore, PA
National Provider Identifier
1023010329
Registry record updated Jan 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
77740501 Issued in PA
Legal business name
TRADITIONAL HOME HEALTH AND HOSPICE LLC
Practice address
113 W Drinker St
Dunmore, PA 18512-1913
Phone
(570) 207-9286
NPI assigned
Jun 1, 2005
Last updated
Jan 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gray P Bossi
Title
Administrator
Phone
(570) 207-9286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 77740501 PA Primary

Addresses

Primary practice location

113 W Drinker St
Dunmore, PA 18512-1913

Mailing address

113 W Drinker St
Dunmore, PA 18512-1913
Phone (570) 207-9286

Other identifiers 3

IdentifierTypeStateIssuer
817359OtherPABLUE CROSS PROVIDER NUMBE
83241OtherPAGEISINGER PROVIDER NUMBER
0019095000003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030701000019 PA Part A Provider - Home Health Agency 2668382656 Practice locations: Berwick, PA; Dunmore, PA; East Stroudsburg, PA
O20221024000864 PA Part A Provider - Home Health Agency 2668382656 Practice locations: Williamsport, PA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1023010329. Details of each certification follow.

Home health agency certification: CCN 397774

Legal name
TRADITIONAL HOME HEALTH AND HOSPICE LLC
Doing business as
TRADITIONAL HOME HEALTH CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 22, 2002
Last certification
Jan 18, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
113 W Drinker St
Dunmore, PA 18512-1913

Home health agency certification: CCN 398350

Legal name
TRADITIONAL HOME HEALTH AND HOSPICE LLC
Doing business as
TRADITIONAL PEDIATRIC & ADULT SKILLED HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 22, 2023
Last certification
Sep 8, 2023
Organization structure
LLCProprietary
Incorporated
Mar 28, 2002 in PA
Enrollment address
562 Hepburn St
Williamsport, PA 17701-5005

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Traditional Home Health CareCCN 397774 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Aug 22, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Care Compare: Home health agency

Medicare Care Compare
Listed as
Traditional Pediatric & Adult Skilled Home CareCCN 398350 · All quality measures
Ownership
-
Certified
Sep 22, 2023
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D1076405Traditional Home Health Care113 West Drinker Street, Dunmore, PA 18512Certificate of waiverNov 13, 2027
39D2268852Traditional Pediatric & Adult Skilled Home Care562 Hepburn Street, Williamsport, PA 17701Certificate of waiverSep 18, 2026

National Provider Directory

National Provider Directory
Tax ID family
Traditional Home Health and Hospice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

120 E 3rd St
Berwick, PA 18603
Phone (570) 507-9428

1418 Electric St
Dunmore, PA 18509
Phone (570) 319-0221

1439 Monroe Ave
Ste 6
Dunmore, PA 18509
Phone (570) 319-0221

651 Northern Blvd
South Abington Township, PA 18411
Phone (570) 586-9286

562 Hepburn St
Williamsport, PA 17701
Phone (570) 505-5515

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mario M Costa Individual 5% Or Greater Direct Ownership Interest Mar 31, 2019 32.63%
Corporate OfficerManaging Member Nov 1, 2006 29.67%
5% Or Greater Direct Ownership InterestMember Nov 1, 2006 32.63%
Doreen Marie Nixon Individual W-2 Managing EmployeeDirector of Nursin May 9, 2003
W-2 Managing EmployeeDirector of Nursing May 1, 2002
Shawn Garrick Individual 5% Or Greater Direct Ownership Interest Mar 31, 2019 32.63%
Corporate OfficerManaging Member Nov 1, 2006 29.67%
5% Or Greater Direct Ownership InterestMember Nov 1, 2006 32.63%
Gray-Paul M Bossi Individual 5% Or Greater Direct Ownership Interest Mar 31, 2019 32.63%
Corporate OfficerManaging Member Mar 19, 2014
5% Or Greater Direct Ownership InterestAdministrator Nov 1, 2006 32.63%
Thaddeus Supanek Individual Operational/Managerial ControlOperations Manager Nov 1, 2022
Danyelle Guzzy Individual W-2 Managing EmployeeAssistant Director of Nursing Nov 1, 2022
Erin Stepanski Individual W-2 Managing EmployeeNursingsupervisor Nov 1, 2022

Practitioners & affiliated clinicians

Affiliated clinicians 122

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 122

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1023010329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 W DRINKER ST",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185121913",
            "telephone_number": "570-207-9286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W DRINKER ST",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185121913",
            "telephone_number": "570-207-9286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRADITIONAL HOME HEALTH AND HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "BOSSI",
        "authorized_official_first_name": "GRAY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "570-207-9286",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "77740501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "817359",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER PROVIDER NUMBER",
            "identifier": "83241",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019095000003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunmore, PA

Sources for this page

Verify at the official NPI Registry.