Healthcare Provider Details

I. General information

NPI: 1235581018
Provider Name (Legal Business Name): CGC HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10935 ESTATE LN SUITE S 400 A
DALLAS TX
75238-2316
US

IV. Provider business mailing address

10935 ESTATE LN SUITE S 400 A
DALLAS TX
75238-2316
US

V. Phone/Fax

Practice location:
  • Phone: 469-730-4882
  • Fax: 214-853-4279
Mailing address:
  • Phone: 469-730-4882
  • Fax: 214-853-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KAREN ANN SHORT
Title or Position: DIRECTOR OF NURSES
Credential: RN
Phone: 214-558-7879