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General NPI Number Information
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NPI Number | 1225079643
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Entity Type | Organization
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Legal Business Name | GAMBLE HOSPICE CARE NORTHWEST, LLC
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 8950 E KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71115
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Country | US
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Telephone | 318-861-2150
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Fax | 318-861-2157
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Provider Business Mailing Address
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Address Line | 600 N PEARL ST STE 1050
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City | DALLAS
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State | TX
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Zip | 75201-7495
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Country | US
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Telephone | 214-252-7600
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MICHAEL BEAL
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Credential |
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Telephone | 214-252-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 150
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 2203781702-I
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2203781702
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License Number State | LA
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