MEDICARE: MEMORIAL HOSPICE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1205474418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HOSPICE SERVICES LLC

Provider Business Mailing Address
First Line	:	2084 E WASHINGTON AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-6229
Country	:	US
Telephone Number	:	623-565-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	7207 REGENCY SQUARE BLVD STE 260-26
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3188
Country	:	US
Telephone Number	:	623-565-3922
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ABDALLA ELKHALIFA
Credential	:
Telephone Number	:	623-565-3922

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	03/20/2025

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