MEDICARE: GRACE HOSPICE, 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	009334	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316941818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	730 AVENUE F
Second Line	:	STE 200
City	:	PLANO
State	:	TX
Zip	:	75074-6752
Country	:	US
Telephone Number	:	972-424-3454
Fax Number	:	972-424-3054

Provider Business Practice Location Address
First Line	:	730 AVENUE F
Second Line	:	STE 200
City	:	PLANO
State	:	TX
Zip	:	75074-6752
Country	:	US
Telephone Number	:	972-424-3454
Fax Number	:	972-424-3054

Authorized Official
Title or Position	:	CEO
Name	:	MR. KIRK B WIED
Credential	:
Telephone Number	:	972-424-3454

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/08/2017

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Directions to “GRACE HOSPICE, LLC ” Practice Location

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