MEDICARE: LIFEPATH HOSPICE AND PALLIATIVE CARE INC

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	:	1235120197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEPATH HOSPICE AND PALLIATIVE CARE INC

Provider Business Mailing Address
First Line	:	12973 N TELECOM PKWY
Second Line	:	STE 100
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0907
Country	:	US
Telephone Number	:	813-871-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	12973 N TELECOM PKWY
Second Line	:	STE 100
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0907
Country	:	US
Telephone Number	:	813-871-8111
Fax Number	:	813-975-9621

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	GEORGE H WALLACE
Credential	:
Telephone Number	:	813-871-8111

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/22/2020

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