NPIMap

Organization Active NPI

Residential Healthcare of NE PA, LLC

  • Community Based Hospice Care Agency
  • Moosic, PA
National Provider Identifier
1487955290
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
RESIDENTIAL HEALTHCARE OF NE PA, LLC
Practice address
50 Glenmaura National Blvd Ste 202
Moosic, PA 18507-2124
Phone
(888) 923-5842
NPI assigned
Nov 10, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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

Authorized official

Name
Justin Dewitte
Title
President
Phone
(877) 421-0917

Specialties & licenses 1

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

Addresses

Primary practice location

50 Glenmaura National Blvd Ste 202
Moosic, PA 18507-2124

Mailing address

400 Northpointe Cir Ste 203
Seven Fields, PA 16046-7867

Other practice location 1

601 Wyoming Ave
Kingston, PA 18704-3701
Phone (888) 923-5842

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110111000336 PA Part A Provider - Hospice 1658560396 Practice locations: Moosic, PA

Hospice certification: CCN 391572

Legal name
RESIDENTIAL HEALTHCARE OF NE PA LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 11, 1993
Last certification
Nov 6, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Mar 19, 2019 in PA
Enrollment address
50 Glenmaura National Blvd
Ste 202
Moosic, PA 18507-2124

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
Residential Healthcare of NE PA, LLCCCN 391572
Ownership
For-Profit
Certified
Aug 11, 1993
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Residential Healthcare of NE PA LLC3 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

50 Glenmaura National Blvd
Ste 202
Moosic, PA 18507
Phone (888) 923-5842

400 Northpointe Cir
Ste 203
Seven Fields, PA 16046

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
Karen Sloaf Individual Operational/Managerial ControlDirector of Regulatory Affairs Oct 9, 2025
Leeann Lang Individual Corporate OfficerSenior VP of Administration Oct 9, 2025
Jamie Barber Individual W-2 Managing EmployeeAdministrator Aug 24, 2023
Wendy R Bongero Individual Operational/Managerial ControlSenior Vice President of Operations Nov 18, 2022
Nicholas D Dodge Individual Contracted Managing EmployeeMD; Jan 14, 2025
Graham Healthcare Group Inc Organization, Arlington, VA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Nov 5, 2012 100%
Deedrea Grein Individual Corporate OfficerCeo Dec 1, 2025
Graham Holdings Company Organization, Arlington, VA Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jul 2, 2018 100%
Jason Pierce Individual Corporate OfficerCfo Oct 9, 2025
Amy Kent Individual Operational/Managerial ControlVP of Operations Nov 18, 2022
Celtic Healthcare Inc & Qualified Subsidiaries Organization, Troy, MI Corporation, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2011 100%

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 29

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

View all 29

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1289347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1487955290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 NORTHPOINTE CIR STE 203",
            "city": "SEVEN FIELDS",
            "state": "PA",
            "postal_code": "160467867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 GLENMAURA NATIONAL BLVD STE 202",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185072124",
            "telephone_number": "888-923-5842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Wyoming Ave",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "PA",
            "postal_code": "187043701",
            "country_code": "US",
            "telephone_number": "888-923-5842",
            "fax_number": "724-742-4451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RESIDENTIAL HEALTHCARE OF NE PA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-10",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "DEWITTE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "877-421-0917"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moosic, PA

Sources for this page

Verify at the official NPI Registry.