365 Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · State College, PA
NPI 1376750398 · NPPES record last updated Sep 12, 2025
Key facts
- NPI
- 1376750398
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- 365 HOSPICE, LLC
- Practice address
- 1315 W College Ave Ste 303
State College, PA 16801-2776 - Phone
- (814) 946-5017
- Fax
- (814) 308-9947
- NPI assigned
- May 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Jonathan C Rezk
- Title
- Cfo
- Phone
- (814) 946-5017
Owners & managing parties with NPI records 4
-
Zane H Gates, M.D.
-
Brandon M Roscoe, M.D.
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 4
Affiliated clinicians 18
-
Dillard Elmore, D.O., MBA
-
Eric K Fowler, MD
-
Meena Gella, D.O.
-
Margaret Mary Hallahan, D.O.
-
Amanda Mae Olson, D.O.
-
Brandon M Roscoe, M.D.
-
Dennis A. Shannon III, M.D.
-
Michael Tanitsky, DO
Medicare Care Compare: Hospice
- Listed as
- 365 Hospice LLC
- Ownership
- For-Profit
- Certified
- Oct 22, 2007
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Hospice certification: CCN 391691
- Legal name
- 365 HOSPICE, LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Oct 22, 2007
- Last certification
- Jul 14, 2021
- Ownership / control type
- Proprietary - Individual
- Organization structure
- LLC · Proprietary
- Incorporated
- May 3, 2007 in PA
- Enrollment address
- 1315 W College Ave
Ste 303
State College, PA 16801-2776
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| George M Zlupko |
Operational/Managerial Control |
May 20, 2024 | |
| Michael C Zlupko |
Operational/Managerial Control |
May 20, 2024 | |
| John Rezk |
5% Or Greater Direct Ownership Interest |
Jun 1, 2007 | 100% |
| Debbie Phillips |
Operational/Managerial Control |
May 20, 2024 | |
| Zane H Gates |
Operational/Managerial Control |
May 20, 2024 | |
| Francesca Gildea |
Operational/Managerial Control |
May 20, 2024 | |
| Thomas Rezk |
Operational/Managerial Control |
May 20, 2024 | |
| Brandon M Roscoe |
Operational/Managerial Control |
May 20, 2024 | |
| Jonathan C Rezk |
Corporate Officer |
Jul 1, 2016 | |
| W-2 Managing Employee |
Aug 1, 2012 | ||
| Operational/Managerial Control |
Aug 1, 2012 | ||
| Brenda J Romanini |
Operational/Managerial Control |
Jul 9, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070607000449 | PA | Part a Provider - Hospice | 6406954841 | Practice locations: State College, PA |
National Provider Directory
- Tax ID family
- 365 Hospice LLC
Locations
1315 W College Ave
Ste 303
State College, PA 16801
Phone (518) 307-1990
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
1315 W College Ave Ste 303
State College, PA 16801-2776
Mailing address
119 S Main St
Carrolltown, PA 15722-0477
Phone (814) 419-4901
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1020513330001 | Medicaid | PA | |
| 16911601 | Other | PA | STATE OF PENNSYLVANIA |
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All providers in State College, 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 12, 2025. 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.