=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538599147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMEGALIFE HOSPICE OF TEXAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2013
-----------------------------------------------------
Last Update Date | 12/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5625 CYPRESS CREEK PKWY STE 418
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-912-5927
-----------------------------------------------------
Fax | 832-912-5928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5625 CYPRESS CREEK PKWY STE 418
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-912-5927
-----------------------------------------------------
Fax | 832-912-5928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOAQUIN C DIAZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-518-5508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------