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General NPI Number Information
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NPI Number | 1013225473
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Entity Type | Organization
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Legal Business Name | PALLIATIVE PERFORMANCE GROUP LLC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 414 W EULESS BLVD
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City | EULESS
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State | TX
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Zip | 76040-4538
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Country | US
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Telephone | 817-501-8812
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Fax | 817-857-1035
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Provider Business Mailing Address
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Address Line | 2529 E. LANCASTER STE C
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City | FORT WORTH
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State | TX
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Zip | 76103
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Country | US
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Telephone | 817-907-6714
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Fax | 817-529-5030
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA ROBERTS
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Credential | DO
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Telephone | 817-907-6714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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