Healthcare Provider Details

I. General information

NPI: 1669886040
Provider Name (Legal Business Name): CKD HOSPICE & PALLIATIVE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E DALLAS ST STE 2
MANSFIELD TX
76063-2029
US

IV. Provider business mailing address

1015 E DALLAS ST STE 2
MANSFIELD TX
76063-2029
US

V. Phone/Fax

Practice location:
  • Phone: 844-767-3931
  • Fax: 817-704-3188
Mailing address:
  • Phone: 844-767-3931
  • Fax: 817-704-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number016517
License Number StateTX

VIII. Authorized Official

Name: CHIKETA KELLY
Title or Position: ADMINISTRATOR
Credential:
Phone: 844-767-3931