NPIMap

Organization Active NPI

Interim Healthcare Hospice of Western Pennsylvania Inc

Doing business as Interim HealthCare Hospice and Palliative Care

  • Community Based Hospice Care Agency
  • Johnstown, PA
National Provider Identifier
1417210980
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
INTERIM HEALTHCARE HOSPICE OF WESTERN PENNSYLVANIA INC
Doing business as
Interim HealthCare Hospice and Palliative Care
Practice address
322 Warren St
Suite 270
Johnstown, PA 15905-3443
Phone
(814) 262-8305
Fax
(814) 254-1236
NPI assigned
Jun 20, 2012
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Thomas J Dimarco
Title
Chief Executive Officer
Phone
(614) 436-9404

Specialties & licenses 1

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

Addresses

Primary practice location

322 Warren St
Suite 270
Johnstown, PA 15905-3443

Mailing address

322 Warren St
Suite 220
Johnstown, PA 15905-3443
Phone (814) 262-8305

Other names 1

  • Interim HealthCare Hospice and Palliative Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120828000520 PA Part A Provider - Hospice 5092865204 Practice locations: Johnstown, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417210980. Details of each certification follow.

Hospice certification: CCN 391756

Legal name
INTERIM HEALTHCARE HOSPICE OF WESTERN PENNSYLVANIA, INC.
Doing business as
INTERIM HEALTHCARE HOSPICE AND PALLIATIVE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 20, 2013
Last certification
Nov 16, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 19, 2008 in PA
Enrollment address
322 Warren St
Ste 250
Johnstown, PA 15905-3443

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Interim Healthcare Hospice & Palliative CareCCN 391756 · All quality measures
Ownership
For-Profit
Certified
Feb 20, 2013
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Interim Healthcare Hospice of Western Pennsylvania Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

322 Warren St
Ste 270
Johnstown, PA 15905
Phone (814) 255-2181

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Stephanie Wiedner Individual W-2 Managing EmployeeAdministrator Mar 21, 2023
Operational/Managerial ControlAdministrator Mar 21, 2023
Kevin S Murphy Individual Operational/Managerial ControlRegional Vice President Sep 30, 2024
Salo Inc Organization, Worthington, OH For-profit 5% Or Greater Direct Ownership Interest Jun 24, 2012 100%
Jason Merkle Individual Corporate OfficerVice President Hospice Operations Mar 11, 2024
W-2 Managing EmployeeVice President Hospice Operations Mar 11, 2024
Christine D Oswald Individual 5% Or Greater Indirect Ownership InterestPresident/Cfo Jun 24, 2012 8.56%
Corporate OfficerPresident/Cfo Sep 1, 2019
Corporate DirectorBoard Member Jun 24, 2012
Richard Michael Kastelic Individual Operational/Managerial ControlAdministrator May 30, 2025
Thomas Joseph Dimarco Individual 5% Or Greater Indirect Ownership InterestCeo Jun 24, 2012 75.78%
Corporate OfficerCeo Sep 1, 2019
Corporate DirectorBoard Member & Director Jun 24, 2012
Diane S Piccard Individual Corporate OfficerChief Clinical Officer Jul 19, 2016

Owners & managing parties with NPI records 1

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

Facilities with the same owner 24

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

View all 24

Practitioners & affiliated clinicians

Affiliated clinicians 12

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": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1417210980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 WARREN ST",
            "address_2": "SUITE 220",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159053443",
            "telephone_number": "814-262-8305",
            "fax_number": "814-254-1236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 WARREN ST",
            "address_2": "SUITE 270",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159053443",
            "telephone_number": "814-262-8305",
            "fax_number": "814-254-1236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERIM HEALTHCARE HOSPICE OF WESTERN PENNSYLVANIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "DIMARCO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "614-436-9404",
        "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": [
        {
            "organization_name": "Interim HealthCare Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Interim HealthCare Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnstown, PA

Sources for this page

Verify at the official NPI Registry.