=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114597416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELOVED PALLIATIVE HOSPICE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2021
-----------------------------------------------------
Last Update Date | 06/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11336 MEMSIE CT
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-232-1045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11336 MEMSIE CT
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | STANLEY MBAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-232-1045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------