MEDICARE: AMERICAN MEMORIAL CARE HOSPICE

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	163WH1000X	Hospice Registered Nurse

General Provider Information

NPI Number	:	1912957515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN MEMORIAL CARE HOSPICE

Provider Business Mailing Address
First Line	:	7619 PORTAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1828
Country	:	US
Telephone Number	:	713-995-9347
Fax Number	:	713-995-9348

Provider Business Practice Location Address
First Line	:	16300 KUYKENDAHL RD
Second Line	:	#500
City	:	HOUSTON
State	:	TX
Zip	:	77068-2752
Country	:	US
Telephone Number	:	713-995-9347
Fax Number	:	713-995-9348

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LISA D WAGNER
Credential	:
Telephone Number	:	832-563-3237

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/22/2020

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Directions to “AMERICAN MEMORIAL CARE HOSPICE ” Practice Location

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