NPIMap

Traditional Home Health and Hospice LLC

Organization Active NPI Community Based Hospice Care Agency · Dunmore, PA

NPI 1154500445 · NPPES record last updated Jan 8, 2020

Key facts

NPI
1154500445
Entity type
Organization (NPI type 2)
Primary specialty
Community Based Hospice Care Agency 251G00000X
Legal business name
TRADITIONAL HOME HEALTH AND HOSPICE LLC
Practice address
113 W Drinker St
Dunmore, PA 18512-1913
Phone
(570) 207-9286
Fax
(570) 207-9287
NPI assigned
Nov 2, 2007
Organization subpart
No

Authorized official

Name
Mr. Gray-Paul Bossi
Title
Owner/Administrator
Phone
(570) 207-9286

Owners & managing parties with NPI records 2

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

Other NPIs with the same Medicare PAC ID 1

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

Corporate family (same tax ID) 1

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

Affiliated clinicians 7

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

Medicare Care Compare: Hospice

Listed as
Traditional Hospice CCN 391701
Ownership
For-Profit
Certified
Mar 10, 2008
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PA

Hospice certification: CCN 391701

Legal name
TRADITIONAL HOME HEALTH AND HOSPICE LLC
Doing business as
TRADITIONAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 10, 2008
Last certification
Oct 23, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLC · Proprietary
Incorporated
Mar 28, 2002 in PA
Enrollment address
113W Drinker St
Dunmore, PA 18512-1913

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.

NameRoleSinceShare
Daniel J Kazmierski
Individual 		Contracted Managing Employee
MD;		 Mar 18, 2008 50%
Mario M Costa
Individual 		5% Or Greater Direct Ownership Interest Mar 31, 2019 32.63%
Corporate Officer
Board Member		 Nov 1, 2006
Shawn Garrick
Individual 		5% Or Greater Direct Ownership Interest Mar 31, 2019 32.63%
Corporate Officer
Board Member		 Nov 1, 2006
Gray-Paul M Bossi
Individual 		5% Or Greater Direct Ownership Interest Mar 1, 2008 32.63%
Corporate Director
Administrator		 Mar 1, 2008
W-2 Managing Employee
Administrator		 Mar 1, 2008 32.63%
Matthew C Haley
Individual 		Contracted Managing Employee
MD;		 Mar 18, 2008 50%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20071107000237 PA Part a Provider - Hospice 2668382656 Practice locations: Dunmore, PA

National Provider Directory

Tax ID family
Traditional Home Health and Hospice LLC (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Yes

Addresses

Primary practice location

113 W Drinker St
Dunmore, PA 18512-1913

Mailing address

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 8, 2020.

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1154500445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 WEST DRINKER ST",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "18512",
            "telephone_number": "570-207-9286",
            "fax_number": "570-207-9287"
        },
        {
            "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",
            "fax_number": "570-207-9287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRADITIONAL HOME HEALTH AND HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "BOSSI",
        "authorized_official_first_name": "GRAY-PAUL",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "570-207-9286",
        "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": []
}

Other providers in Dunmore, PA

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

Sources for this page

Verify at the official NPI Registry.