=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831582121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXACARE HOSPICE INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2015
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12100 FORD RD STE 275
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-688-0414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12100 FORD RD STE 275
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-688-0414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | LAARNIE BRAVO REGALA
-----------------------------------------------------
Credential | B.S.N., R.N., W.C.N
-----------------------------------------------------
Telephone | 469-688-0414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------