1457495434 NPI number — HEART TO HEART HOSPICE OF FORT WORTH, 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 1457495434 NPI number — HEART TO HEART HOSPICE OF FORT WORTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART TO HEART HOSPICE OF FORT WORTH, 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:
Provider Other Organization Name Type Code:
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:
1457495434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7240 CHASE OAKS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-5901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-479-0844
Provider Business Mailing Address Fax Number:
972-479-0413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 SOUTHWEST BLVD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-731-9700
Provider Business Practice Location Address Fax Number:
817-731-9708
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
972-479-0844

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  011415 , 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: 001015199 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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