Healthcare Provider Details

I. General information

NPI: 1083204903
Provider Name (Legal Business Name): SOLEMNITY HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/31/2021
Certification Date: 01/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CENTRAL PKWY E STE 220
PLANO TX
75074-5584
US

IV. Provider business mailing address

520 CENTRAL PKWY E STE 220
PLANO TX
75074-5584
US

V. Phone/Fax

Practice location:
  • Phone: 469-626-0041
  • Fax:
Mailing address:
  • Phone: 469-626-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: TRACI COOPER
Title or Position: ADMIN/SUP NURSE
Credential:
Phone: 214-543-6341