1326219874 NPI number — ANGEL CARE HOSPICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326219874 NPI number — ANGEL CARE HOSPICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL CARE HOSPICE LLC
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:
ANGEL CARE 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:
1326219874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
702 FAIR PARK DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75654-3266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-657-2461
Provider Business Mailing Address Fax Number:
903-657-8796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 FAIR PARK DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75654-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-657-2461
Provider Business Practice Location Address Fax Number:
903-657-8796
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
BURT
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
903-657-8969

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12010 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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