Healthcare Provider Details

I. General information

NPI: 1013225473
Provider Name (Legal Business Name): PALLIATIVE PERFORMANCE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W EULESS BLVD
EULESS TX
76040-4538
US

IV. Provider business mailing address

2529 E. LANCASTER STE C
FORT WORTH TX
76103
US

V. Phone/Fax

Practice location:
  • Phone: 817-501-8812
  • Fax: 817-857-1035
Mailing address:
  • Phone: 817-907-6714
  • Fax: 817-529-5030

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: PATRICIA ROBERTS
Title or Position: PRESIDENT
Credential: DO
Phone: 817-907-6714