Healthcare Provider Details

I. General information

NPI: 1740739234
Provider Name (Legal Business Name): CCD HOSPICE MP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 20TH ST STE 101
MOUNT PLEASANT TX
75455-2325
US

IV. Provider business mailing address

201 W 20TH ST STE 101
MOUNT PLEASANT TX
75455-2325
US

V. Phone/Fax

Practice location:
  • Phone: 903-572-3777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number017788
License Number StateTX

VIII. Authorized Official

Name: TRENT CARGILE
Title or Position: CFO
Credential:
Phone: 903-575-7030