Healthcare Provider Details

I. General information

NPI: 1447872171
Provider Name (Legal Business Name): AMIRACLE HOSPICE AND PALLIATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 EAST FWY
HOUSTON TX
77029-1974
US

IV. Provider business mailing address

11811 EAST FWY STE 328
HOUSTON TX
77029-1982
US

V. Phone/Fax

Practice location:
  • Phone: 832-509-6853
  • Fax:
Mailing address:
  • Phone: 832-509-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: AGNES J BERRY
Title or Position: OWNER
Credential:
Phone: 832-509-6853