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General NPI Number Information
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NPI Number | 1467045997
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Entity Type | Organization
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Legal Business Name | GRACEFUL HEART HOSPICE LLC
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 4402 BROADWAY BLVD STE 14F
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City | GARLAND
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State | TX
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Zip | 75043-8263
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Country | US
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Telephone | 214-394-6821
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Fax | 214-593-3235
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Provider Business Mailing Address
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Address Line | 3671 BROADWAY BLVD STE 500-B3
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City | GARLAND
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State | TX
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Zip | 75043
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Country | US
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Telephone | 214-394-6821
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Fax | 214-593-3235
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | SHIBU SAMUEL
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Credential |
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Telephone | 214-394-6821
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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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