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General NPI Number Information
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NPI Number | 1073829479
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Entity Type | Organization
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Legal Business Name | TRICARE HOSPICE, LLC
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 25673 HIGHWAY 105 W
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City | CLEVELAND
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State | TX
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Zip | 77328-2973
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Country | US
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Telephone | 281-358-8000
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Fax | 281-358-7999
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Provider Business Mailing Address
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Address Line | 25673 HIGHWAY 105 W
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City | CLEVELAND
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State | TX
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Zip | 77328-2973
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Country | US
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Telephone | 281-358-8000
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Fax | 281-358-7999
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRANDI TRAHAN
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Credential |
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Telephone | 281-358-8000
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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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Taxonomy #2
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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 | TX
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