1306837893 NPI number — FOREFRONT LIVING HOSPICE

Table of content: (NPI 1306837893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306837893 NPI number — FOREFRONT LIVING HOSPICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOREFRONT LIVING HOSPICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAITH HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306837893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12477 MERIT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-239-5300
Provider Business Mailing Address Fax Number:
214-355-3950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12477 MERIT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-239-5300
Provider Business Practice Location Address Fax Number:
214-355-3950
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON-COOK
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
KIMBERLY
Authorized Official Title or Position:
CORPORATE COMPLIANCE DIRECTOR
Authorized Official Telephone Number:
214-413-1566

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315D00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001012621 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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