NPIMap

Organization Active NPI

Traditional Home Health and Hospice LLC

  • Community Based Hospice Care Agency
  • Dunmore, PA
National Provider Identifier
1154500445
Registry record updated Jan 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 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
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-Paul Bossi
Title
Owner/Administrator
Phone
(570) 207-9286

Specialties & licenses 1

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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154500445. Details of each certification follow.

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
LLCProprietary
Incorporated
Mar 28, 2002 in PA
Enrollment address
113W Drinker St
Dunmore, PA 18512-1913

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: Hospice

Medicare Care Compare
Listed as
Traditional HospiceCCN 391701 · All quality measures
Ownership
For-Profit
Certified
Mar 10, 2008
Medicare certification status
ActiveFrom the Provider of Services file

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.

Ownership & related parties

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 EmployeeMD; Mar 18, 2008 50%
Mario M Costa Individual 5% Or Greater Direct Ownership Interest Mar 31, 2019 32.63%
Corporate OfficerBoard Member Nov 1, 2006
Shawn Garrick Individual 5% Or Greater Direct Ownership Interest Mar 31, 2019 32.63%
Corporate OfficerBoard Member Nov 1, 2006
Gray-Paul M Bossi Individual 5% Or Greater Direct Ownership Interest Mar 1, 2008 32.63%
Corporate DirectorAdministrator Mar 1, 2008
W-2 Managing EmployeeAdministrator Mar 1, 2008 32.63%
Matthew C Haley Individual Contracted Managing EmployeeMD; Mar 18, 2008 50%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "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

Sources for this page

Verify at the official NPI Registry.