Signal PA Hospice, LLC | NPI 1043783236

Key facts

NPI: 1043783236
Entity type: Organization (NPI type 2)
Primary specialty: Community Based Hospice Care Agency 251G00000X
Legal business name: SIGNAL PA HOSPICE, LLC
Practice address: 1716 Main St
Blakely, PA 18447
Phone: (570) 342-3314
NPI assigned: Jan 10, 2019
Organization subpart: Yes
Parent organization (as reported): SIGNAL PA HOSPICE, LLC

Authorized official

Name: Mark Siderowicz
Title: Ceo
Phone: (570) 342-3314

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Francis J Schell, MD Emergency Medicine Physician · Carbondale, PA · NPI 1639164395

CMS ownership OTHER

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Signal PA Home Health, LLC Home Health Agency · Blakely, PA · NPI 1033682364

NPD member Member Of

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

PHHC Scranton Hospice, LLC Community Based Hospice Care Agency · Dunmore, PA · NPI 1831580281

CMS change of ownership Acquired from · 2019-01-01

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Signal PA Home Health, LLC Home Health Agency · Blakely, PA · NPI 1033682364

CMS ownership SIGNAL PA HOLDINGS, LLC

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Jesse Kabana, MSN, CRNP, FNP-C Family Medicine Physician · Blakely, PA · NPI 1184344376

NPD FAMILY MEDICINE
Francis J Schell, MD Emergency Medicine Physician · Carbondale, PA · NPI 1639164395

NPD (past)

Medicare Care Compare: Hospice

Listed as: Personal Home Healthcare and Hospice CCN 391772
Ownership: For-Profit
Certified: Oct 2, 2015
Medicare certification status: Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
39D2238330	Signal PA Hospice 1716 Main St, Blakely, PA 18447	Certificate of waiver	Oct 1, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in PA

Hospice certification: CCN 391772

Legal name: SIGNAL PA HOSPICE LLC
Doing business as: PERSONAL HOME HEALTHCARE AND HOSPICE
Certification status: Active
Provider type (POS): Hospice
Participating since: Oct 2, 2015
Last certification: Oct 28, 2021
Ownership / control type: Proprietary - Individual
Organization structure: LLC · Proprietary
Incorporated: Oct 5, 2018 in PA
Enrollment address: 233 Main Street
Blakely, PA 18447

All disclosed owners & managing parties 5

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
Francis Schell Individual	Other Medical Director	Jul 1, 2024
Mark Siderowicz Individual	W-2 Managing Employee Executive Director	Mar 1, 2019
Judy Lee Longo Individual	Operational/Managerial Control Administrator	Jan 1, 2019
Signal PA Holdings, LLC Organization · Dunmore, PA LLC	5% Or Greater Direct Ownership Interest	Jan 1, 2019	95%
Gary McDonough Individual	5% Or Greater Direct Ownership Interest President	Oct 2, 2020	5%
	5% Or Greater Indirect Ownership Interest President	Oct 2, 2020	95%
	Corporate Officer President	Oct 2, 2020
	W-2 Managing Employee President	Oct 2, 2020

Change-of-ownership history

Date	Event	Counterparty
Jan 1, 2019	Change of Ownership This provider was the buyer	PHHC Hospice CCN 391772 · PA · NPI 1831580281

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20190226001810	PA	Part a Provider - Hospice	1759620354	Practice locations: Blakely, PA

National Provider Directory

Part of: Signal PA Hospice LLC

Locations

1716 Main St
Blakely, PA 18447
Phone (570) 342-3314

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Community Based Hospice Care Agency	251G00000X			Yes

Addresses

Primary practice location

1716 Main St
Blakely, PA 18447

Mailing address

1716 Main St
Blakely, PA 18447
Phone (234) 466-0990

Other names

Personal Home Health Care and Hospice Doing business as

Other providers in Blakely, PA

Craig Thomas Scanland, DPM
John A Scanland, DPM
Michael Senyk, DC
Alexandra Sharpe
Signal PA Home Health, LLC
Smola Chiropractic
Paul M Smola, DC
Michael A. Stachacz, D.C
Stefanelli Counseling and Consulting LLC
Marlee Lynn Stefanelli, MS, LPC, RD, LDN

All providers in Blakely, PA · Community Based Hospice Care Agency in Pennsylvania

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.