Provider Demographics
NPI:1447472006
Name:OPTUM PALLIATIVE AND HOSPICE CARE OF PENNSYLVANIA, INC.
Entity type:Organization
Organization Name:OPTUM PALLIATIVE AND HOSPICE CARE OF PENNSYLVANIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-616-7221
Mailing Address - Street 1:1009 WINDCROSS CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-224-5440
Mailing Address - Fax:
Practice Address - Street 1:700 AMERICAN AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:610-265-2006
Practice Address - Fax:610-265-2766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLABORATIVE CARE HOLDINGS, LL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
PA16951601251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based