Healthcare Provider Details

I. General information

NPI: 1679169064
Provider Name (Legal Business Name): AGLOW HOSPICE CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2020
Last Update Date: 12/19/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 STONEHILL DR
PLANO TX
75025-2564
US

IV. Provider business mailing address

8016 STONEHILL DR
PLANO TX
75025-2564
US

V. Phone/Fax

Practice location:
  • Phone: 469-702-1948
  • Fax:
Mailing address:
  • Phone:
  • 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: CHARLES EBERE OKPARA
Title or Position: NP
Credential: FNP-BC
Phone: 602-909-8026