NPIMap

Organization Active NPI

Constellation Home Care LLC

Doing business as Constellation Hospice

  • Community Based Hospice Care Agency
  • Orange, CT
National Provider Identifier
1417239088
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0032 Issued in CT
Legal business name
CONSTELLATION HOME CARE LLC
Doing business as
Constellation Hospice
Practice address
240 Indian River Rd
Orange, CT 06477-3649
Phone
(203) 497-3888
NPI assigned
Sep 9, 2011
Last updated
Sep 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Authorized official

Name
Ms. Joane Walsh
Title
Ceo
Phone
(203) 845-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0032 CT Primary

Addresses

Primary practice location

240 Indian River Rd
Orange, CT 06477-3649

Mailing address

14 Westport Ave
Norwalk, CT 06851-3915
Phone (203) 845-8000

Other names 1

  • Constellation Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111130000027 CT Part A Provider - Hospice 0941388078 Practice locations: Norwalk, CT; Rocky Hill, CT; Orange, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417239088. Details of each certification follow.

Hospice certification: CCN 071542

Legal name
CONSTELLATION HOME CARE LLC
Doing business as
CONSTELLATION HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 13, 2012
Last certification
May 5, 2022
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Jun 13, 2012 in CT
Enrollment address
240 Indian River Rd
Orange, CT 06477-3649

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
Constellation Home CareCCN 071542 · All quality measures
Ownership
For-Profit
Certified
Jun 13, 2012
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Constellation Home Care 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.

Locations

2080 Silas Deane Hwy
Ste 305
Rocky Hill, CT 06067
Phone (203) 845-8000

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Marvin J. Ostreicher Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 31.78%
Andrew William Lyons Individual W-2 Managing EmployeeMD; Feb 1, 2020
David Ostreicher Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 5%
Barry Bokow Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 10%
Marc E Ostreicher Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 16.11%
Elizabeth Almeida Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 10%
Ira Geffner Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 6%
Yitzchok Steg Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 16.11%
Constellation Health Services LLC Organization, Norwalk, CT LLC, Holding company, For-profit Other May 18, 2009 100%
Jason a Creutzmann Individual Corporate OfficerAdministrator Jun 27, 2016 100%
W-2 Managing EmployeeAdministrator Jun 27, 2016 100%
Rebecca Lopiansky Individual 5% Or Greater Direct Ownership Interest Apr 14, 2011 5%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 166

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

View all 166

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1417239088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 WESTPORT AVE",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068513915",
            "telephone_number": "203-845-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 INDIAN RIVER RD",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773649",
            "telephone_number": "203-497-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSTELLATION HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-09",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "JOANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-845-8000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CT",
            "license": "0032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Constellation Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CT

Sources for this page

Verify at the official NPI Registry.