Active NPI
365 Hospice, LLC
- Community Based Hospice Care Agency
- Carrolltown, PA
National Provider Identifier
1033555776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- 365 HOSPICE, LLC
- Practice address
- 115 S Main St
Carrolltown, PA 15722-7206 - Phone
- (814) 419-4901
- Fax
- (814) 419-4902
- NPI assigned
- May 21, 2013
- Last updated
- May 26, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jonathan Rezk
- Title
- VP Finance
- Phone
- (814) 946-5017
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
115 S Main St
Carrolltown, PA 15722-7206
Mailing address
PO Box 477
Carrolltown, PA 15722-0520
Phone (814) 419-4901
Other names 1
- HORIZONS HOSPICE, LLC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140430000084 | PA | Part A Provider - Hospice | 6406954841 | Practice locations: Carrolltown, PA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1033555776. Details of each certification follow.
Hospice certification: CCN 391774
- Legal name
- 365 HOSPICE, LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Sep 23, 2015
- Last certification
- Mar 4, 2021
- Ownership / control type
- Proprietary - Individual
- Organization structure
- LLC
- Incorporated
- Jun 5, 2007 in PA
- Enrollment address
- 115 S Main St
Carrolltown, PA 15722-7206
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Care Compare: Hospice
Medicare Care Compare- Listed as
- 365 Hospice LLC
- Ownership
- For-Profit
- Certified
- Sep 23, 2015
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- 365 Hospice LLC
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community Based Hospice Care Agency
- State College, PA
- NPI 1376750398
-
- Community Based Hospice Care Agency
- Belle Vernon, PA
- NPI 1497159222
-
- Community Based Hospice Care Agency
- Monroeville, PA
- NPI 1841459872
Locations
115 S Main St
Carrolltown, PA 15722
Phone (814) 344-8994
119 S Main St
Carrolltown, PA 15722
Ownership & related parties
All disclosed owners & managing parties 8
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Amy McMurray | Operational/Managerial Control | Feb 23, 2024 | |
| John Rezk | 5% Or Greater Direct Ownership Interest | Mar 1, 2014 | 100% |
| Corporate Officer | Mar 1, 2014 | 100% | |
| Eric Heasley | Operational/Managerial Control | Feb 23, 2024 | |
| Thomas Rezk | Operational/Managerial Control | Feb 23, 2024 | |
| Brandon M Roscoe | Operational/Managerial Control | Feb 23, 2024 | |
| Jonathan C Rezk | Corporate Officer | Mar 1, 2014 | |
| W-2 Managing Employee | Mar 1, 2014 | ||
| Operational/Managerial Control | Mar 1, 2014 | ||
| Patrick Michael Gray | Operational/Managerial Control | Feb 23, 2024 | |
| Georgia Lord-Waugaman | Operational/Managerial Control | Feb 23, 2024 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Windber, PA
- NPI 1427040088
Operational/Managerial Control
-
- Internal Medicine Physician
- Blairsville, PA
- NPI 1811954837
Operational/Managerial Control
-
- Family Medicine Physician
- Du Bois, PA
- NPI 1639394034
Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 26
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369094400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1621987200000",
"number": "1033555776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 477",
"city": "CARROLLTOWN",
"state": "PA",
"postal_code": "157220520",
"telephone_number": "814-419-4901",
"fax_number": "814-419-4902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 S MAIN ST",
"city": "CARROLLTOWN",
"state": "PA",
"postal_code": "157227206",
"telephone_number": "814-419-4901",
"fax_number": "814-419-4902"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "365 HOSPICE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-05-21",
"last_updated": "2021-05-26",
"certification_date": "2021-05-26",
"status": "A",
"authorized_official_last_name": "REZK",
"authorized_official_first_name": "JONATHAN",
"authorized_official_title_or_position": "VP FINANCE",
"authorized_official_telephone_number": "814-946-5017",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "HORIZONS HOSPICE, LLC",
"code": "4",
"type": "Former Legal Business Name"
},
{
"organization_name": "HORIZONS HOSPICE, LLC",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Carrolltown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.