MEDICARE: MEMORIAL 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

General Provider Information

NPI Number	:	1396167318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HOSPICE, LLC

Provider Business Mailing Address
First Line	:	1201 SANTA ROSA ST
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-3919
Country	:	US
Telephone Number	:	361-739-7016
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 SANTA ROSA ST
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-3919
Country	:	US
Telephone Number	:	361-739-7016
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	MRS. TARA MENDIETTA
Credential	:	RN
Telephone Number	:	361-739-7016

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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Directions to “MEMORIAL HOSPICE, LLC ” Practice Location

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