MEDICARE: COVENANT HOSPICE & PALLIATIVE CARE 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	011688	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45-1791	OTHER	TX	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	011688	OTHER	TX	STATE HOSPICE LICENSE

General Provider Information

NPI Number	:	1417139619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT HOSPICE & PALLIATIVE CARE LLC

Provider Business Mailing Address
First Line	:	10 CADILLAC DR STE 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1001
Country	:	US
Telephone Number	:	615-377-7022
Fax Number	:	615-373-4457

Provider Business Practice Location Address
First Line	:	2630 WEST FWY STE 130
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-7117
Country	:	US
Telephone Number	:	817-735-8741
Fax Number	:	817-735-8836

Authorized Official
Title or Position	:	SVP GENERAL COUNSEL
Name	:	MR. RUSSELL G ADKINS
Credential	:
Telephone Number	:	615-309-5668

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	06/09/2020

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Directions to “COVENANT HOSPICE & PALLIATIVE CARE LLC ” Practice Location

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