=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790282945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILEAD COMMUNITY HOME HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2018
-----------------------------------------------------
Last Update Date | 03/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2104 ROOSEVELT DR SUITE M
-----------------------------------------------------
City | DALWORTHINGTON GARDENS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76013-5937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-801-7100
-----------------------------------------------------
Fax | 817-801-7101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2104 ROOSEVELT DR STE M
-----------------------------------------------------
City | DALWORTHINGTON GARDENS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76013-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-801-7100
-----------------------------------------------------
Fax | 817-801-7101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | BRENT KORTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-579-8741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------