=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164724993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGEND HOSPICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2010
-----------------------------------------------------
Last Update Date | 04/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 S HULEN ST STE 304
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76109-4911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-324-4565
-----------------------------------------------------
Fax | 214-919-4510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18601 LYNDON B JOHNSON FWY STE 110
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-5629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-324-4565
-----------------------------------------------------
Fax | 214-919-4510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. GEORGE THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-324-4565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------