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General NPI Number Information
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NPI Number | 1134561640
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HOSPICE LLC
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 17950 PRESTON RD STE 475
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City | DALLAS
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State | TX
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Zip | 75252-5793
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Country | US
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Telephone | 972-290-0041
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Fax | 972-408-3457
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Provider Business Mailing Address
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Address Line | 17950 PRESTON RD STE 440
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City | DALLAS
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State | TX
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Zip | 75252-5793
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Country | US
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Telephone | 972-290-0041
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Fax | 972-408-3457
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Authorized Official
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Title or Position | PRESIDENT
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Name | MADMADHAN NAIR
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Credential |
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Telephone | 214-675-1201
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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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