MEDICARE: DPM ALLIANCE HOSPICE AGENCY, 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	010480	TX

General Provider Information

NPI Number	:	1902001159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DPM ALLIANCE HOSPICE AGENCY, LLC

Provider Business Mailing Address
First Line	:	6760 OLD JACKSONVILLE HWY STE 101
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0566
Country	:	US
Telephone Number	:	903-363-9932
Fax Number	:	817-326-2436

Provider Business Practice Location Address
First Line	:	1125 CYPRESS STATION DR STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3055
Country	:	US
Telephone Number	:	713-522-0160
Fax Number	:	713-524-3693

Authorized Official
Title or Position	:	CHIEF GROWTH OFFICER/GOVERNING BODY
Name	:	KATRINA DAWN LANIER
Credential	:
Telephone Number	:	903-363-2436

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	09/26/2024

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