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General NPI Number Information
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NPI Number | 1629757075
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Entity Type | Organization
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Legal Business Name | SOUTHERN GRACE HOSPICE LLC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 301 S MCDONALD ST # 100A
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City | MCKINNEY
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State | TX
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Zip | 75069-5669
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Country | US
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Telephone | 214-548-5919
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 CEDARBROOK LN
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City | PROSPER
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State | TX
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Zip | 75078-8972
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELLIE OWENS-GIBSON
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Credential | RN, BSN
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Telephone | 469-714-2570
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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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