Hospice of the Sacred Heart
Organization Active NPI Community Based Hospice Care Agency · Moosic, PA
NPI 1063498541 · NPPES record last updated Jul 17, 2024
Key facts
- NPI
- 1063498541
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 16561601 (PA)
- Legal business name
- HOSPICE OF THE SACRED HEART
- Practice address
- 30 Ed Preate Dr Ste 108
Moosic, PA 18507-1755 - Phone
- (570) 706-2400
- Fax
- (570) 970-9717
- NPI assigned
- Dec 16, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Diane Baldi, RN,CHPN
- Title
- Executive Director
- Phone
- (570) 706-2400
Owners & managing parties with NPI records 1
Affiliated clinicians 55
-
Essam M Almeky, MD
-
Ibrahim M Almeky, MD
-
Tamrat Bekele, MD
-
Michael Vito Brown, M.D.
-
Devin Carey, M.D.
-
Kevin James Carey, D.O.
-
Darlene Ann Dunay, D.O.
-
Guy Michael Fasciana, M.D.
-
Yaman Gibran, M.D.
-
Michael J Grasso, MD
-
Matthew C Haley, DO
-
Jared David Hill, MD
-
Jamie A Hopkins, D.O.
-
Stephen Gerard Jaditz, D.O.
-
Daniel Joseph Kazmierski, M.D.
-
Patrick Kilduff, D.O.
-
John M Kish, D.O.
Medicare Care Compare: Hospice
- Listed as
- Hospice of the Sacred Heart
- Ownership
- Non-Profit
- Certified
- May 26, 2004
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D1025482 | Hospice of the Sacred Heart | Certificate of waiver | May 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Hospice certification: CCN 391656
- Legal name
- HOSPICE OF THE SACRED HEART
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- May 26, 2004
- Last certification
- Jan 13, 2022
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 18, 2003 in PA
- Enrollment address
- 30 Ed Preate Dr
Ste 108
Moosic, PA 18507-1755
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Dominick L Denaples |
Corporate Director |
Apr 26, 2005 | |
| Diane M Baldi |
Corporate Officer |
Mar 10, 2004 | |
| W-2 Managing Employee |
Aug 18, 2003 | ||
| Frank a Bucci |
Corporate Officer |
Mar 10, 2004 | |
| Corporate Director |
Mar 10, 2004 | ||
| John Anecki |
Corporate Officer |
Mar 10, 2004 | |
| Corporate Director |
Mar 10, 2004 | ||
| Robert Tambur |
Corporate Director |
Mar 3, 2004 | |
| Sam Lesante |
Corporate Director |
Mar 10, 2004 | |
| Linda Weiland |
W-2 Managing Employee |
Sep 18, 2012 | |
| Bryan E Boyle |
Corporate Officer |
Jun 17, 2008 | |
| Corporate Director |
Jun 17, 2008 | ||
| William Reber |
Corporate Director |
Mar 10, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040303000030 | PA | Part a Provider - Hospice | 4284529009 | Practice locations: Moosic, PA |
National Provider Directory
Locations
30 Ed Preate Dr
Moosic, PA 18507
30 Ed Preate Dr
Ste 108
Moosic, PA 18507
Phone (570) 706-2400
53 Glenmaura National Blvd
Ste 120
Moosic, PA 18507
600 Baltimore Dr
Wilkes Barre, PA 18702
Phone (570) 706-2400
130 Wilkes Barre Township Blvd
Wilkes Barre, PA 18702
Phone (570) 706-2400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 16561601 | PA | Yes |
| Community Based Hospice Care Agency | 251G00000X |
Addresses
Primary practice location
30 Ed Preate Dr Ste 108
Moosic, PA 18507-1755
Mailing address
30 Ed Preate Dr Ste 108
Moosic, PA 18507-1755
Phone (570) 706-2400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1011014860001 | Medicaid | PA |
Other providers in Moosic, PA
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- Jacob Herber
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- Jade Lynn Holley
- Laurann Teresa Hoover
- Hospital Drive Homecare, Inc
- Alexis Marie Huff
- Ahna Nicole Hyrowich
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All providers in Moosic, 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 Jul 17, 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.