1730660218 NPI number — SCENIC HEALTHCARE HOSPICE LLC

Table of content: (NPI 1730660218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730660218 NPI number — SCENIC HEALTHCARE HOSPICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCENIC HEALTHCARE 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:
Provider Other Organization Name Type Code:
6
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:
1730660218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1292 FM-157
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-717-7819
Provider Business Mailing Address Fax Number:
682-400-8842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1292 FM-157
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-717-7819
Provider Business Practice Location Address Fax Number:
682-400-8842
Provider Enumeration Date:
08/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
682-717-7819

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




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