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General NPI Number Information
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NPI Number | 1568802882
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Entity Type | Organization
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Legal Business Name | CLEARPATH HOSPICE OF FORT WORTH, LLC
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 1164 W PIONEER PKWY
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City | ARLINGTON
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State | TX
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Zip | 76013-6367
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Country | US
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Telephone | 435-753-3133
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Fax | 435-753-3542
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Provider Business Mailing Address
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Address Line | 545 W 465 N STE 100
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City | PROVIDENCE
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State | UT
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Zip | 84332-8004
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Country | US
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Telephone | 435-753-3133
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Fax | 435-753-3542
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUSTIN LARSEN
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Credential |
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Telephone | 435-753-3133
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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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